On electrocardiographic findings of pulmonary air embolism:Case report and experimental study Toru Takahashi 1 , Shinichi Yamamoto 1 , Kaoru Shirai 1 , Tetsuo Nakata 1 , Chuichi Tanimura 1 1Emergency Center, Kyoto Second Red Cross Hospital pp.201-207
Published Date 1986/2/15
DOI https://doi.org/10.11477/mf.1404204826
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Case report: A 53 y.o. female known to have a pelvic mass with a fistula to sigmoid colon developed a sudden cardiovascular collapse, on inflating the sigmoid colon with ca. 300 cc of air during colono-scopy. Clinical diagnosis of pulmonary air embo-lism was confirmed by the aspiration of 10 cc of frothy blood from the right ventricle. Initial EKG's showed ventricular tachycardia, then S1Q3T3 pattern with ST elevation in aVR, III, and V1-V2. Elevation of myocardial enzymes was also noted and sub-sequent EKG's were compatible with myocardial damage, presumably in the right ventricle.

On animal experiment using two dogs, bolus in-jections of 2 ml/kg body weight air into the femo-ral vein did reveal the ST-T elevations in the right precordial leads, starting a few seconds later and disappearing in several minutes.

Review of the literature suggests this EKG change is possibly due to severe ischemia of the right ven-tricular muscle, because of the loss of pressure gra-dient between the aorta and the right ventricular wall. Further experimental study to elucidate the mechanism to explain the occasional ST elevation in acute cor pulmonale, as seen in this particular case of pulmonary air embolism, shall be under-taken.

Copyright © 1986, Igaku-Shoin Ltd. All rights reserved.


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