- Key ECG: Pathognomonic for acute severe R heart strain (the most common etiology by far being acute PE). V2-V3 have the most important pathognomonic morphology here, with the small R wave followed by large S wave, then slightly convex ST segment followed by terminal-to-whole T wave inversion. Paired with the classic simultaneous “inferior and anterior” T wave inversion
- Note: Kosuge’s study found that ALL cases of PE with precordial T-wave inversion have an inverted T wave in lead III and ALL cases of MI have an upright T wave in lead III:
- Link to full case @ Dr. Smith’s ECG Blog: 2021-03-3