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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