SUMMARYWe present the case of a 65-year-old man with an atypical presentation of pulmonary embolism (PE) as ST elevation myocardial infarction (STEMI) with high troponin. He presented with acute exertional dyspnoea without chest pain. Since the initial ECG showed ST elevation anteroseptal (V1-V4) with concomitant deep Q waves, a delayed STEMI with probable left ventricular aneurysm was the working diagnosis and was treated accordingly. Nevertheless, his coronary angiography was normal and it was then that PE was suspected. D-dimer was found to be elevated and CT pulmonary angiography confirmed bilateral PE with a large thrombus within the right main pulmonary artery. The patient made good clinical recovery and his ST elevation resolved with anticoagulation. The source was found to be a deep vein thrombosis in his right leg. The treatment was not compromised by the delayed diagnosis as he received timely anticoagulation as part of STEMI management. BACKGROUND

No abstract

Humans are all exposed to many different forms of radiation -radio waves, microwaves, ultraviolet, Xrays, etc. The form of radiation involved in Nuclear Medicine is called ionising radiation. This poster will provide advice to haemodialysis staff that may have to carry out dialysis on patients who have received ionising radiation as part of a medical investigation. All patients who are referred to the Nuclear Medicine Department for imaging procedures are given an injection of a pharmaceutical preparation with a radioactive compound attached to it. The vast majority of the patients are studied using Technetium -99m as a radioactive tag but on occasions, compounds like Iodine -123 and Gallium-67 are also used. The different radioactive materials have different physical decay rates. Following administration of the pharmaceutical agent, the patient is deemed "radioactive". For this reason, unless it is clinically justified, haemodialysis should not be performed on patients in the 24 h period after a nuclear medicine injection. However, if haemodialysis is required, certain protocols must be carried out, because some risks are associated with the procedure. The main risks associated with these patients are external irradiation, internal contamination and fluid over load. Due to the short half-life of the radioactivity, these risks, in general, only warrant control in the 24 h period following the radioactive injection.