Scenario: An 86-year-old female was admitted to a medical-surgical unit from an extended care facility with complaints of abdominal pain and vomiting. She remained on complete bed rest due to severe pain and was ultimately diagnosed with acute sigmoid diverticulitis. After 4 days, an ECG (below) was obtained when she suddenly became anxious, short of breath, and hypoxic. On admission, her ECG showed normal sinus rhythm (76/min) with a right bundle branch block (RBBB).

Sinus tachycardia with an RBBB (criteria: QRSd > 120 milliseconds, slurred S wave in leads I and V6, rSR′ pattern in V1, where R′ > R) and ECG criteria suggestive of pulmonary embolism (PE)

A PE is an unpredictable condition associated with high morbidity and mortality in hospitalized patients.

Following a PE, acute hypoxia develops and fluid volume overload in the right ventricle (acute core pulmonale) occurs. Key ECG features include tachycardia,...

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