Electrocardiographic Characteristics of Pulmonary Embolism in Patients Hospitalized at Dalal Jamm National Hospital Center (2021–2023)

Introduction: Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. In Africa, limited access to computed tomography pulmonary angiography (CTPA) enhances the clinical value of the electrocardiogram (ECG), a rapid and widely available tool, for early diagnostic orientation and prognostic assessment. Objectives: To describe ECG abnormalities observed in patients with acute pulmonary embolism and to analyze their association with in-hospital mortality and paraclinical markers of severity. Methods: We conducted a retrospective, descriptive, and analytical study including 103 patients hospitalized for confirmed pulmonary embolism in the cardiology department of the National Hospital Center Dalal Jamm, Dakar, Senegal, between January 1, 2021 and December 31, 2023. Clinical characteristics, risk factors, biological parameters, transthoracic echocardiographic findings, and CTPA results were collected. The associations between isolated or cumulative ECG abnormalities and in-hospital mortality were analyzed. Results: The mean age was 53 years, with a female predominance (male-to-female ratio: 0.84). The main risk factors were obesity (36.2%), age >70 years (31.9%), prolonged immobilization (24.6%), underlying heart disease (13%), and gynecological factors (14.5%). The most common symptoms were dyspnea (83.5%), chest pain (67%), and cough (49.5%). The most frequent ECG abnormalities were sinus tachycardia (62.1%), subepicardial ischemia (47.6%), the S1Q3T3 pattern (38.8%), and right-sided conduction disturbances, including right bundle branch block (20.4%). Transthoracic echocardiography revealed right heart chamber dilation (50%), pulmonary hypertension (38.8%), and intracardiac thrombus (6.3%). CTPA showed bilateral PE in 29.1% of cases, right-sided PE in 15.5%, and left-sided PE in 9.7%. All patients received anticoagulation therapy. In-hospital mortality risk was significantly higher in patients presenting with at least two cumulative ECG abnormalities and was strongly associated with right heart dilation and pulmonary hypertension. Conclusion: Pulmonary embolism represents a significant clinical burden in Senegal. Although nonspecific, the ECG provides valuable information for early suspicion and prognostic stratification, particularly in emergency settings with limited resources. The presence of multiple ECG abnormalities identifies patients at high risk of early mortality. Early recognition of these findings, combined with risk factor assessment and evaluation of right ventricular involvement, may facilitate timely management and improve patient outcomes.