{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T18:51:51Z","timestamp":1758394311326},"reference-count":13,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2009,2,3]],"date-time":"2009-02-03T00:00:00Z","timestamp":1233619200000},"content-version":"vor","delay-in-days":3747,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[1998,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Electocardiographic (ECG) findings of pulmonary embolism (PE) include S<jats:sub>1<\/jats:sub>Q<jats:sub>3<\/jats:sub>T<jats:sub>3<\/jats:sub> pattern, right bundlebranch block, right\u2010axis deviation, and T\u2010wave inversion in medial precordial leads. We report other uncommon ECG changes associated with various symptoms during recurrent PE as documented by computed tomography (CT) scans in a single patient. An 83\u2010year\u2010old woman was admitted with PE secondary to deep venous thrombosis in the left leg. During episodes of chest pain, ECG showed QTc prolongation (480 ms) with new T\u2010wave inversion in leads III, aVF, and V<jats:sub>1<\/jats:sub>\u2010V<jats:sub>3<\/jats:sub>, and ST\u2010segment depression in leads V<jats:sub>5<\/jats:sub>\u2010V<jats:sub>6<\/jats:sub>. Despite adequate anticoagulant therapy, recurrent episodes of PE occurred in the hospital. When the patient experienced sudden chest tightness, ECG showed a new S\u2010wave notch in lead V<jats:sub>1<\/jats:sub> and clockwise rotation with sinus tachycardia. She also experienced transient syncope with hypotension. At this time, ECG showed transient atrioventricular junctional rhythm followed by sinus arrest, and CT scan showed a new massive embolus in the main pulmonary trunk with right ventricular dilatation, as demonstrated by echocardiography. The mechanism responsible for QTc prolongation with ST\u2010T changes, the S\u2010wave notch in lead V<jats:sub>1<\/jats:sub> with clockwise rotation, or atrioventricular junctional rhythm with sinus arrest during PE may be associated with myocardial ischemia, acute right ventricular overload, or vagal reflex, respectively.<\/jats:p>","DOI":"10.1002\/clc.4960211117","type":"journal-article","created":{"date-parts":[[2009,2,4]],"date-time":"2009-02-04T02:22:40Z","timestamp":1233714160000},"page":"858-861","source":"Crossref","is-referenced-by-count":5,"title":["Uncommon electrocardiographic changes corresponding to symptoms during recurrent pulmonary embolism as documented by computed tomography scans"],"prefix":"10.1002","volume":"21","author":[{"given":"Takuya","family":"Watanabe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuji","family":"Kikushima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaoru","family":"Tanno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiichi","family":"Geshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youichi","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youichi","family":"Takeyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Katagiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,2,3]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(72)90613-3"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0033-0620(75)80016-8"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000174504"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90237-2"},{"key":"e_1_2_1_6_2","first-page":"688","volume-title":"Comprehensive Electrocardiogy: Theory and Practice in Health and Disease","author":"Harumi K","year":"1989"},{"key":"e_1_2_1_7_2","first-page":"1588","volume-title":"Heart Disease: A Textbook of Cardiovascular Medicine","author":"Goldhaber SZ","year":"1997"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(95)90155-8"},{"key":"e_1_2_1_9_2","first-page":"1698","volume-title":"Comprehensive Cardiovascular Medicine","author":"Sgarbossa EB","year":"1998"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(92)90672-I"},{"key":"e_1_2_1_11_2","first-page":"94","volume-title":"Electrocardiography in Clinical Practice","author":"Chou TC","year":"1996"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(93)90433-A"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.249.3.390"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(96)00690-X"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fclc.4960211117","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.4960211117","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,29]],"date-time":"2023-10-29T00:33:41Z","timestamp":1698539621000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.4960211117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1998,11]]},"references-count":13,"journal-issue":{"issue":"11","published-print":{"date-parts":[[1998,11]]}},"alternative-id":["10.1002\/clc.4960211117"],"URL":"https:\/\/doi.org\/10.1002\/clc.4960211117","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[1998,11]]}}}