Compression of the pulmonary artery can occur with mediastinal metastases from a lung cancer. Routine monitoring of the ECG can help to identify this complication.
Situation: compression of pulmonary artery, causing right heart strain
Changes seen on the ECG:
(1) right axis deviation
(2) deep S wave in lead I
(3) substantial R wave in lead aVR
(4) inverted or flat T waves in limb leads
(5) inverted or flat T waves in precordial leads
Differential diagnosis includes pulmonary embolism, coronary artery disease and chemotherapy-induced cardiomyopathy. CT pulmonary angiography (CTPA) can aid in clarifying the diagnosis.
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