ICCU duty interesting cases ! ( Acute Pul.Embolsim )

A 30 years old man brought to ICCU by complain of new onset severe dyspnea without PND, Orthopnea , chest pain ....etc
W/o any history of DVD and leg swelling and long time bed rest which he was physically active BP 90/60 , HR 150 , RR-28 , no any other considerable addiction and family history of CAD and Blood test not shown hypercoagulable state, CXR had not considerable changes still , D dimer was not match to disease , after ECG shown typical view of PE and echo shown RV and RA dilatation, RV dysfunction , severe pul.hypertension , and pulmonary artery thormbosis recorded and CT angiography . but extremity doppler was not documented any clod and occlusion . After tPa infusion over 2 hours he compeletly calm and HR decreased and dyspnea slowly resolved .
Typical ECG of PE :
the most specific finding on an ECG is the classic S1Q3T3 pattern , but the most common finding non-specific ST-segment and T-wave chages.
Other coomonly reported findings include sinus tachycardia , Right bundle branch block .
Like chest radiography , the major utility of ECG is the diagnosis of PE is to rule out the other major diagnosis such as acute MI .