Missed PE, patient died

[u/Repulsive_Knee1304]

Throwaway account as to be expected.

I had a younger obese smoker male patient come in recently for shortness of breath that was exertional in nature, he said it started after he recently started working out. Patient was a smoker, 1/2 pack a day. SOB Resolved upon rest. patient states that he was carrying some heavy containers at work today, and noticed the shortness of breath again. No chest pain. No diaphoreses . No fever. No lower extremity swelling. No recent uri. Perc negative. Low pretest probability. Physical exam was significant for an expiratory wheeze, diminished sounds at bases. Patient got Breathing treatments, steroids and felt better. Reexamination showed improved aerations. Patient was discharged on steroids, albuterol. EKG NSR rate of 74, t wave inversions in v1-v3. No inversion in lead 3. No st changes. Cxr portable showed poor inspiratory effort, cardiomegaly( rotational?) but read as normal by radiologist and myself. Completely stable vitals. O2 sat of 95%, no tachy. No chest pain. Sob got better. Perc negative. Patient died at home 2 days later. Someone said PE. My guilt is consuming me. How fucked am i

EKG- S1,small q3. No t wave inversions in III. So no t3. Sinus rythym rate of 74 Qrs 88. Upright axis V1-v3 t wave inversions. No previous to compare to

[u/karleksbarn]

Swedish attending. I've had worse misses, as have most of us.

T-wave inversions in v1-v3 is pathognomic for acute rv strain and should raise suspicion for PE, along with other common ecg changes.

Take it with you, learn and spread your experience.

[u/Wahrnehmung → u/karleksbarn]

V1-V3 inversion is nonspecific and absolutely not pathognomonic

[u/karleksbarn → u/Wahrnehmung]

Yes you are correct that anterior T-wave inversion by itself is non-specific. As noted in a follow up post it is highly pathognomic for rv strain and PE in the clinical setting of new onset dyspnea.

Would you argue with this?