QuestionSBA
QuestionChoice
This vignette suggests a diagnosis of pulmonary embolism, with sudden onset pleuritic chest pain and oxygen requirement, combined with several risk factors for VTE (obesity and use of COCP). The most common finding on ECG for patients with a PE is sinus tachycardia.
Whilst S1Q3T3 is a specific finding, it is not the most common finding.
10028316
a
Sinus tachycardia
QuestionChoice
This may be seen if the history was suggestive of an infection e.g. pneumonia (which can commonly trigger AF) or if palpitations/pre-syncope were described.
10028319
d
An irregularly irregular rhythm with an absence of P waves
QuestionChoice
This is normally seen in hyperkalaemia. There is nothing in the history to suggest hyperkalaemia as the admission VBG is normal.
10028320
e
Tall tented T waves
QuestionChoice
This is concerning for myocardial infarction rather than PE. A right bundle branch block may be observed in unstable PE due to right heart strain.
10028318
c
New left bundle branch block
QuestionChoice
Whilst this is a specific finding for a PE, it is much less commonly seen than sinus tachycardia.
10028317
b
S1Q3T3 pattern
Concept
Chapter
2693
3724
Pulmonary Embolism
Topic
132
Respiratory
18061
The most likely ECG finding in pulmonary embolism (PE) is sinus tachycardia, while the most specific finding is the S1Q3T3 pattern, which indicates right heart strain and is highly specific but less common.
A 47-year-old woman has sudden onset shortness of breath and pleuritic chest pain. She has a history of type II diabetes and obesity.
She medication history includes metformin and the combined oral contraceptive pill.
Her saturations are 98% on 4 litres of oxygen via nasal cannulae. Her chest X-ray and VBG are both normal.

Given the most likely diagnosis, what is the most likely finding on her ECG?
a