‘STEMI–like’ acute pulmonary embolism, an unusual presentation

Abstract

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

Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction

“…The literature search yielded a total of 2732 publications. Following the exclusion criteria, 2699 citations were excluded, leaving 91 articles reviewed, 33 articles included, 2–34 with 34 adult cases for analysis.…”

Pulmonary Embolism Initially Misdiagnosed as Perimyocarditis in a Young Patıent

“…ECG is one of the indispensable diagnostic tools in evaluating the patients with chest pain and dyspnea. Patients with PE may demonstrate a variety of electrocardiographic changes, including alterations in rate, rhythm, conduction, axis, and morphology[ 5 ]; however, most of these alterations are non-specific, thus, their diagnostic value is limited. These alterations may be because of right ventricular overload, dilation, ischemia, and/or increased sympathetic activity.…”

Leriche syndrome in a patient with acute pulmonary embolism and acute myocardial infarction: a case report and review of literature

“…After three weeks of' anticoagulation therapy, his D-dimer level normalized, pulmonary embolus disappeared while abnormal findings on ECG, TTE, and myocardial perfusion PET remained. According to the literature, various ECG manifestations have been well described in the setting of APE, including pulmonary P waves, right axis deviations, S1S2S3, S1Q3T3, T waves inversions, ST depressions and ST elevations [2,10,11]. Abnormal echocardiography, such as McConnell sign, have also been noted [10][11][12][13].…”

“…According to the literature, various ECG manifestations have been well described in the setting of APE, including pulmonary P waves, right axis deviations, S1S2S3, S1Q3T3, T waves inversions, ST depressions and ST elevations [2,10,11]. Abnormal echocardiography, such as McConnell sign, have also been noted [10][11][12][13]. However, these changes were always transient and could resolve quickly after successful anticoagulation therapy [10,12,14].…”