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Asymptomatic pulmonary embolus masquerading as acute anteroseptal myocardial infarction

Published online by Cambridge University Press:  11 May 2015

Jeanne Noble*
Department of Emergency Medicine, University of California, San Francisco, CA
Amandeep Singh
Department of Emergency Medicine, Alameda Country Medical Center, Highland Hospital, Oakland, CA
Department of Emergency Medicine, University of California, San Francisco, 505 Parnassus Avenue, Room L138, San Francisco, CA 94143-0208;


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Pulmonary embolism (PE) is an uncommon and often overlooked cause of ST-segment elevation on the electrocardiogram (ECG). Emergent echocardiography has been cited as a means to rapidly distinguish acute myocardial infarction from PE. However, both of these conditions can present with focal wall motion abnormalities. We report a case of a 51-year-old asymptomatic male who presented to our emergency department with anterior ST-segment elevation and right-heart strain on an ECG. The clinical diagnosis of ST elevation myocardial infarction was in doubt, and an echocardiogram was obtained while the patient was in the emergency department. Although a focal area of hypokinesia was observed on echocardiography, cardiac catherization did not demonstrate any evidence of acute coronary occlusion. A computed tomographic angiogram of the chest was subsequently obtained, which demonstrated evidence of submassive pulmonary emboli. Our case highlights the limited utility of emergent echocardiography in cases of ST-segment elevation.

Case Report • Rapport de cas
Copyright © Canadian Association of Emergency Physicians 2011



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