PMC7593723_01
(a) Chest X-ray, PA view on initial presentation to emergency room showing increased interstitial markings bilaterally. (b) Chest X-ray, AP view done on patient's second emergency room visit showing bilateral patchy consolidations and worse in right lung fields. (c) Chest X-ray, PA view on hospital day 3 showing persistent bilateral patchy consolidations improved from hospital day 1. (d) Chest X-ray, PA view on hospital day 7 showing improved bilateral consolidations.
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fig1
Chest X-ray (CXR) revealed increased vascular markings, especially at the left base (Figure 1(a)). 12 lead ECG showed sinus rhythm with normal axis, right bundle branch block, and inverted anterior T waves without other changes. CXR revealed bilateral patchy infiltrates consistent with multifocal pneumonia, right greater than left lung field, and he was intubated with the diagnosis of COVID-19 pneumonia (Figure 1(b)). Repeat CXR showed persistent bilateral patchy opacities (Figure 1(c)). Repeat CXR and ECG are shown in Figures 1(d) and 2(b), respectively.
(a) 12 lead EKG on the day of acute pulmonary embolism diagnosis showing sinus rhythm, heart rate of 90 bpm, PR interval of 145 ms, QRS duration of 145 ms, QTc of 420 ms, and QRS axis of 35 degrees. S1Q3T3 RV strain pattern with right bundle branch block (RBBB). (b) 12 lead EKG on day 5 of ICU admission: sinus rhythm, heart rate of 70 bpm, PR interval of 130 ms, QRS duration of 150 ms, QTc of 430 ms, QRS axis of 17 degrees, and RBBB. Diffuse T wave changes.
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Bedside 12 lead ECG revealed evidence of RV strain (Figure 2(a)).