S WAVE IN PULMONARY EMBOLISM, A NEW ECG SIGN TO AID THROMBOLYSIS

Kerala Heart Journal. 2012;2(2):9-14

 

Journal Homepage

Journal Title: Kerala Heart Journal

ISSN: 2347-5269 (Print); 2454-6755 (Online)

Publisher: Cardiological Society of India, Kerala Chapter

Society/Institution: Cardiological Society of India, Kerala Chapter

LCC Subject Category: Medicine: Medicine (General) | Medicine: Surgery

Country of publisher: India

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS

Thomas John (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Sajan Ahmad Z (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Prabha Nini Gupta (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Praveen GK (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Krishna Kumar B (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Rajasekharan VR (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Suresh (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Deepak Madhu (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Sanjeev (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Shivaprasad K (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
A George Koshy (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)
Sunita Vishwanathan (Department of Cardiology Medical College, Thiruvanathapuram, Kerala, India)

EDITORIAL INFORMATION

Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 12 weeks

 

Abstract | Full Text

Acute pulmonary embolism is a devastating disease that often leads to mortality . Previous investigators have found that thrombolysis reduces mortality in men but not significantly in women with pulmonary embolism. Many of the previous studies are with tenecteplase and alteplase. Here, we describe intra - venous thrombolysis with streptokinase in seven patients with pulmonary embolism who survived including two women. Further, we have one patient who had a new onset of S wave in lead I which subsequently disappeared after embolectomy. We also comment on the usefulness of shock sign in 2 deciding on thrombolysis .We propose a new sign for noninvasive assessment of need for thrombolysis in pulmonary embolism. New onset S wave in Lead I in pulmonary embolism can be used as a new sign for deciding the need for thrombolysis. When added to the shock sign it can be used in the emergency deparment to decide the need for thrombolysis. Further, there are no clear end points as to when to stop thrombolysis. In all 4 patients we switched to heparin when spontaneous bleeding or oozing started. In all 4 patients subsequent CT scans showed that the patient has mild to moderate resolution of the pulmonary embolism and patients remained stable and have been discharged and are under regular follow up. Hence we propose that bleeding can be used as an end point for thrombolysis in acute pulmonary embolism. We also describe a patient who had new onset S wave that disappeared after successful pulmonary embolectomy. Probably, the S wave is a marker of main pulmonary artery branch occlusions.