<prompt> In acute pulmonary embolism, the ECG finding may include all exceptS1Q3T3 patternP. pulmonaleSinus tachycardiaT-wave inversion in leads V1 to V4  <response>: The most frequently cited abnormality, in addition to sinus tachycardia, is the S1Q3T3 sign: an S wave in lead I, a Q wave in lead III, and an inveed T wave in lead III. This finding is relatively specific but insensitive. RV strain and ischemia cause the most common abnormality, T-wave inversion in leads V1 to V4.Ref: Harrisons 19e pg: 1633 