#KYJ the S1Q3T3
Cardiac Refresher on Cor Pulmonale, or Right heart strain.
Imagine the patient presents with chest pain.
Our go to assessment tool for any chest pain presentation is the good old ECG. You perform the ecg and on assessment your patient shows no ST elevation or depression, no obvious widespread T wave abnormalities, and no LBBB.
Naturally the clinical assessment of their pain and any shortness of breath will be contiguous with your initial ECG.
Your patient seems to be breathless, and holding their Sats >90%, and there is limited (if any) ankle swelling.
Pain onset was described as sudden, and SOB is a feature.
You’ve ruled out T1MI (previously called a STEMI); and have a low suspicion of a Type 2 or 3 MI (NSTEMI)
But the patient is in pain and it seems to be eased by GTN.
Bloods for Troponin are collected among others, and sent for processing (or you ran them through the ISTAT).
Troponin - normal.
Let’s look closer at that seemingly normal ECG.
Tachy at 104
Lead I shows a larger S wave than R
Lead III shows a Q wave and it’s T wave is flattened or inverted.
It is a classic (frequently missed pattern called #S1Q3T3 - hashtag (#) added by me.
This pattern on the ecg is indicative of an increase of Right heart distress.
Now think this through. The Right Heart pumps into the lungs. In situations that the lung vessels are diseased, inelastic, engorged, blocked ; the pulmonarywatson vessels become hypertensive .
Right heart trying to pump into a high pressure area (lungs) causes strain and localised lactic acid (overwork) pain, in the Right ventricle. As oxygen demand exceeds delivery, the Right heart becomes ischaemic (hypoxic) compounding the anginal pain.
Right gear strain/failure is called Cor Pulmonale .
It is a secondary cardiac (COR onary) issue to a primary lung (PULMONary) problem.
Really common sudden onset S1Q3T3 patterns are often seen in pulmonary embolism , pneumothorax or acute Asthma presentations.
Two of these obviously present as an initial respiratory issue (Pneumothorax and asthma), but PE usually manifests with pain as the focal complaint.
Acute cor pulmonale is summarised as an increased volume and pressure within the right ventricle due to pulmonary hypertension.
The pain is often both localised lung pain and ischaemic aching heart pain.
It is important to keep these differentials in mind when a patient presents in chest pain, with respiratory distress and the S1Q3T3 pattern.
More? Check out our cardiac KYJs and courses on the website www.ect4health.com.au/whats
