Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Littmann’s EKG Course: Miscellaneous

  • S1Q3T3 is a pattern of acute right heart strain and is not specific to pulmonary embolism.  It may be seen with severe pneumonia, ARDS, tension pneumothorax, or pulmonary hemorrhage.
    • Watch for RSR' in V1, this is a very ominous finding!
      S1Q3T3 Pulmonary Embolism

      An excellent example of S1Q3T3 in a patient with massive PE. Note the ominous RSR' finding in V1.

      S1Q3T3 no PE

      A similar EKG in a patient with pneumonia, hypoxia, and ARDS... with no PE on CTA.

  • Always check the EKG in a syncopal episode.  Brugada pattern - coved ST segments in V1&V2 - is an indication for ICD placement.

    Brugada Pattern

    This young, healthy patient presented with syncope. He died after being sent home with this EKG. It should have been the indication for an implanted ICD.

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