Pulmonary Embolism Presenting as an Anterior ST-elevation Myocardial Infarction: A Case Report

Ladage, Varvara; Jones, M. S.; Ahmad, Faheem; Plamoottil, Cherian; Misek, Ryan; Alexander-Anyaogu, Nicole

doi:10.5811/cpcem.2020.7.48421

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…Higher right ventricular pressure and depressed cardiac output cause coronary hypoperfusion followed by right ventricular myocardial infarction. [8][9][10][11][12][13][14] Our patient was a man in his early 70 s whose ECG showed ST-segment elevation (by approximately 0.1-0.4 mV) in leads V1 to V3 with an upward T-wave, and the postoperative ECG showed that the ST-segment in leads V1-V3 had fallen back with inversion of the T-wave. Three days later, the inversion amplitude of the T-waves in leads V1 to V3 was reduced (Figure 6).…”

Section: Discussionmentioning

confidence: 84%

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Acute pulmonary embolism presenting with electrocardiographic signs and serum biomarkers of ST-segment elevation myocardial infarction: a case report

Yue,

Shi,

Jiang

et al. 2023

J Int Med Res

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Acute pulmonary embolism (APE) with ST-segment elevation and an upward T-wave is rare, and only a few cases have been reported to date. We herein present a case involving a man in his early 70s with an 8-hour history of dyspnea. Serial electrocardiography (ECG) demonstrated ST-segment elevation in leads V1 to V3 with an upward T-wave, laboratory tests revealed a high serum concentration of high-sensitivity cardiac troponin I, and signs of acute myocardial infarction were present. However, emergency coronary angiography revealed normal coronary arteries. A subsequent computed tomography scan of the pulmonary arteries showed findings consistent with APE. The patient’s chest tightness was relieved after catheter-directed thrombolysis. Postoperative ECG showed that the ST-segment in leads V1 to V3 had fallen back and that the T-wave was inverted. The patient was discharged on rivaroxaban therapy. Clinically, the ECG findings of ST-segment elevation and an upward T-wave in APE can be easily misdiagnosed as acute myocardial infarction. Physicians should maintain clinical suspicion through risk stratification to identify APE.

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Section: Discussionmentioning

confidence: 84%

“…Higher right ventricular pressure and depressed cardiac output cause coronary hypoperfusion followed by right ventricular myocardial infarction. 8 – 14 …”

Section: Discussionmentioning

confidence: 99%

Acute pulmonary embolism presenting with electrocardiographic signs and serum biomarkers of ST-segment elevation myocardial infarction: a case report

Yue,

Shi,

Jiang

et al. 2023

J Int Med Res

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“…17) There are few case reports in literature confirming the presence of STE in patients with a final diagnosis of APE. [19][20][21] Despite the fact that especially in cancer patients and ST deviation in ECG, we always should take APE into account in differential diagnosis on admission, the direct infiltration into LAD appears to be the main reason of such an unexpected clinical presentation in that case. Suga, et al presented a similar case of a YOUNG WOMAN WITH METAPLASTIC BREAST CARCINOMA 73-year-old woman who was admitted to the hospital with the initial diagnosis of STEMI and who was observed fast recurrence of ST segment elevation after balloon angioplasty and initial ECG normalization.…”

Section: Discussionmentioning

confidence: 90%

ST Segment Elevation in a Young Woman with Metaplastic Breast Carcinoma

2023

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The 12-lead electrocardiogram (ECG) remains a key tool to diagnose ST elevation myocardial infarction (STEMI). However, a variety of other conditions aside from obstructive coronary disease, including hyperkalemia, myocarditis, pericarditis, and Takotsubo and Brugada syndrome, may also cause ST segment elevation, with an incidence rate of 3%-15% and mean age of 45 ± 14 years. A combination of a detailed past medical history, thorough physical examination, and additional imaging tests may allow physicians to make the correct diagnosis.In this report, we present a case of a 39-year-old woman with metaplastic breast cancer in the process of combined oncological treatment admitted to the emergency department because of general body weakness, chest pain, and accompanying hypotonia with an initial diagnosis of acute coronary syndrome.The ECG at presentation showed ST segment elevation, but owing to the observed neoplastic cachexia and frailty, she was medically managed and the diagnostics were extended to include transthoracic echocardiogram and computed tomography scan. The patient was found to have an external mass that infiltrated into the thoracic wall, pericardium, right ventricle, interventricular septum, and coronary arteries.In cancer patients with chest pain and ST segment elevation, STEMI should not be the only diagnosis taken into account. In our report, using a combination of available cardiac imaging methods, we were able to evaluate the stage of the lesion and coronary involvement.

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“…PE can cause a large number of EKG changes. The most common of these is sinus tachycardia; however, incomplete or complete right bundle branch block, atrial dysrhythmias, rightward QRS shift, S1Q3T3, acute pulmonary p-wave, T-wave inversion in the right precordial leads, and an anterior ischemic pattern described as inverted T waves in the precordium or ST-elevation have all been described in the literature [ 5 - 8 ]. The anterior ischemic pattern, in conjunction with initial symptoms that can mimic STEMI, presents a diagnostic conundrum to the emergency physician considering CCL activation.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Report of Two Cases

Dina,

Hicks

2024

Cureus

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Pulmonary embolism (PE) is often underrecognized due to its ability to mimic other conditions; however, ultrasound can provide diagnostic clues to aid in the diagnosis of PE. We describe two patients who presented with symptoms suggestive of cardiac ischemia and had electrocardiograms (EKGs) indicative of anteroseptal myocardial infarction. In both cases, cardiac point-of-care ultrasonography showed signs of large pulmonary emboli, which were then confirmed on computed tomography angiography of the chest. Both patients underwent successful aspiration thrombectomy with rapid resolution of cardiac dysfunction. Point-of-care ultrasonography should be used as an adjunct in patients presenting with anterior ischemia on EKG to evaluate for signs of PE.

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Pulmonary Embolism Presenting as an Anterior ST-elevation Myocardial Infarction: A Case Report

Cited by 4 publications

References 16 publications

Acute pulmonary embolism presenting with electrocardiographic signs and serum biomarkers of ST-segment elevation myocardial infarction: a case report

Acute pulmonary embolism presenting with electrocardiographic signs and serum biomarkers of ST-segment elevation myocardial infarction: a case report

ST Segment Elevation in a Young Woman with Metaplastic Breast Carcinoma

Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Report of Two Cases

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