Diagnostic sensitivity and specificity of standard electrocardiogram (ECG) in acute pulmonary embolism (APE) are low. Presence of findings of concomitant right ventricular strain suggests that the use of right-sided ECG recording may be helpful in APE. This study was aimed to investigate the diagnostic usefulness of right-sided ECG in APE.

Patients determined to be at moderate and high risk according to Wells' Criteria and who underwent pulmonary computed tomography angiography imaging were included in the study. Right-sided ECG recording was performed along with standard ECG recording during the first examination of patients.

A total of 117 patients were included in the study. Sixty-four patients (55%) were female. The mean age was 62 ± 16 years for men and 64 ± 17 years for women. Acute pulmonary embolism was detected in 75 patients (64%) by pulmonary computed tomography angiography. Although T-wave inversions were most common in leads V₂ to V₄ (sensitivity, 31%) in standard ECG of patients with APE, right-sided ECG showed T-wave inversions most commonly in V₃R to V₆R (sensitivity, 64%) and ST-segment elevations in V₃R to V₆R (sensitivity, 29%). In APE patients with hypotensive shock, T-wave inversions in leads III and aVF (sensitivity, 57%) in standard ECG and T-wave inversions in V₃R to V₆R (sensitivity, 57%) and ST-segment elevations in V₃R-V₆R (sensitivity, 50%) in right-sided ECG were most commonly observed.

The right-sided ECG has a higher sensitivity than standard ECG for the diagnosis of APE. In patients with clinical APE suspicion, routine use of right-sided ECG along with standard ECG in the first evaluation can be useful.