EMCrit FOAM Feed · Scott D. Weingart, MD FCCM

EMCrit Wee - ECGs in Acute Pulmonary Embolism

February 2, 2026·31 min·2 clips

A doctor was sued after missing T-wave inversions that signaled a pulmonary embolism in a patient with normal vitals.

This episode features Scott Weingart interviewing Pendell Myers, an emergency physician and ECG expert known for developing the OMI paradigm. They examine the role of electrocardiograms in diagnosing pulmonary embolism, prompted by a malpractice case involving a missed PE in a patient with normal vital signs but significant ECG changes. Myers explains he uses the ECG specifically to identify severe right heart strain from a PE, not as a sensitive screening tool. The discussion covers classic ECG findings like sinus tachycardia and the S1Q3T3 pattern, noting their low specificity. Myers emphasizes a pattern of simultaneous anterior and inferior T-wave inversions, particularly in leads V2-V4 and III/aVF, as a key marker of right heart strain. He outlines a differential diagnosis for anterior T-wave inversions, including bundle branch block, Wellens syndrome, hypokalemia, and Takotsubo cardiomyopathy. The conversation addresses complexities like new right bundle branch block or global subendocardial ischemia patterns in PE, which can mimic other conditions like acute coronary occlusion. Myers shares that severe PEs can present without dramatic tachycardia or hypoxemia, making ECG findings crucial. He references studies showing odds ratios for certain T-wave inversions but stresses expert pattern recognition surpasses simple scoring systems. Scott introduces the Daniel score and a more complex novel ECG score, suggesting they serve as checklists rather than practical clinical tools. Myers advocates for bedside echocardiography to confirm right heart strain when the ECG is suggestive. The tone is educational and conversational, blending case-based discussion with practical teaching points. Listeners interested in emergency cardiology, ECG interpretation, and risk management in undifferentiated chest pain will find this episode valuable. Those seeking a deep dive into pulmonary embolism pathophysiology without a focus on diagnostic testing might find it less relevant.

As heard by us

A practical ECG lesson on PE, missed clues, and pattern recognition.

The episode centers on an ECG-on-PE malpractice case: a patient with normal vitals, later found to have PE, while significant anterior and inferior T-wave inversions were missed.

Read the full review in PlayNext →

Why you'd press play

You want to catch PE clues hiding in an ECG before they catch you.

Read the full recommendation in PlayNext →

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from EMCrit FOAM Feed