## **Core Concept**
The electrocardiogram (ECG) is often used as a preliminary diagnostic tool for pulmonary embolism (PE), although it is not highly sensitive or specific. The ECG manifestations of PE can vary widely but typically include signs of right ventricular strain due to the increased pressure load on the right ventricle.

## **Why the Correct Answer is Right**
The most common abnormality in ECG manifestation of pulmonary embolism is **S1Q3T3 pattern**, but more commonly, it presents with **T-wave inversion** in leads V1-V3. This occurs due to the right ventricular strain pattern which can also manifest as right axis deviation, ST-segment changes, and Q waves in lead III. The T-wave inversion in leads V1-V3 is a reflection of the ischemia or strain in the right ventricular wall.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because, although it might represent some form of cardiac abnormality, it is not specified and does not directly relate to the common ECG findings in pulmonary embolism.
- **Option B:** This option is incorrect because, similar to option A, without specification, it's hard to directly link it to the typical ECG manifestations of PE.
- **Option C:** This option might represent another pattern but is not the most common abnormality associated with PE.

## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that while the ECG can show various abnormalities in pulmonary embolism, the **S1Q3T3 pattern** is classic but not the most sensitive. **T-wave inversion in leads V1-V3** is more commonly observed. Remember, a normal ECG does not rule out PE.

## **Correct Answer:** . T-wave inversion in leads V1-V3.