# Syncope Linked to QT‐Interval Prolongation and Global T‐Wave Inversion: A Clinical Case of Acute Pulmonary Embolism

## TL;DR

A 70-year-old patient with chest pain and syncope was diagnosed with acute pulmonary embolism using ECG findings like prolonged QT interval and T-wave inversion.

## Contribution

Highlights a rare ECG presentation of acute pulmonary embolism involving QT prolongation and T-wave inversion, aiding in differential diagnosis.

## Key findings

- Prolonged QT interval and T-wave inversion on ECG were observed in a patient with acute pulmonary embolism.
- Anticoagulant treatment led to normalization of the QT interval.
- ECG features can help distinguish pulmonary embolism from other critical conditions like acute coronary syndrome.

## Abstract

The incidence and mortality rates of acute pulmonary embolism (APE) are high in clinical emergencies, making early diagnosis and risk stratification crucial. Electrocardiogram (ECG) plays a significant role in guiding the diagnosis and differential diagnosis of pulmonary embolism. Acute pulmonary embolism can present with various ECG manifestations. The presence of pulmonary hypertension and increased right ventricular load in pulmonary embolism can lead to T wave inversion in the right cardiac lead. Additionally, some patients may exhibit a prolonged QT interval, which is associated with the pathophysiological processes resulting from both pulmonary hypertension and myocardial ischemia.

Background: Acute pulmonary embolism (APE) is characterized by high incidence, high mortality, and high misdiagnosis rate. Most symptomatic patients with APE have corresponding changes in electrocardiogram, which should be carefully observed and combined with clinical conditions is helpful for diagnosis. Case summary: A 70‐year‐old patient with chest pain and syncope for 1 day presented to the emergency department. The electrocardiogram suggested prolonged QT interval and inversion of prethoracic lead T‐wave. After improving the relevant imaging examination, it was acute pulmonary embolism, and anticoagulant treatment was given for several days, and the QT interval returned to normal. Discussion: Sometimes, it is hard to distinguish acute pulmonary embolism from acute coronary syndrome and aortic dissection because of similar manifestations. Various imaging tests can confirm the diagnosis. These diseases often lead to the appearance of T‐wave inversion and prolonged QT interval in the electrocardiogram. However, a careful analysis of the electrocardiogram can further clarify the corresponding diagnosis.