Serial changes in negative T wave on electrocardiogram in acute pulmonary thromboembolism

A negative T wave is frequently observed in precordial ECG leads in patient s with acute pulmonary thromboembolism. We investigated the clinical signif icance of negative T wave in 15 patients with acute pulmonary thromboemboli sm who were treated with thrombolytic agents by measuring the mean pulmonar y artery pressure and ratio of right to left ventricular end-diastolic diam eter using echocardiography and EGG. The study included only patients with massive acute pulmonary thromboembolism of a mean age of 65+/-9.7 years (+/ -SD). A negative T wave was observed on admission in 10 patients but was la ter detected in 14 of the 15 patients. The mean amplitude of the negative T wave increased within 1 week then decreased after thrombolytic treatment. The peak negative amplitude of the T wave was observed from 1 to 7 days (me an, 2.6+/-1.8 days) and disappeared afterwards. During this period, improve ments in both the mean pulmonary artery pressure (37.8+/-11.2 to 19.1+/-6.7 mmHg) and the ratio of right to left ventricular end-diastolic diameter (0 .97+/-0.16 to 0.51+/-0.13) were noted in all patients. Our results suggest that an increase in the amplitude of negative T wave in precordial leads af ter thrombolytic therapy in patients with massive acute pulmonary thromboem bolism reflects improvement in cardiopulmonary hemodynamics. (C) 1999 Elsev ier Science Ireland Ltd. All rights reserved.