Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-22T19:29:04.875Z Has data issue: false hasContentIssue false

Asymptomatic pulmonary embolus masquerading as acute anteroseptal myocardial infarction

Published online by Cambridge University Press:  11 May 2015

Jeanne Noble*
Affiliation:
Department of Emergency Medicine, University of California, San Francisco, CA
Amandeep Singh
Affiliation:
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; Jeanne_noble@yahoo.com

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

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

References

REFERENCES

1.Fishman, I, Benedict, R, Bakshi, R, et al. Construct validity and frequency of euphoria sclerotica in multiple sclerosis. J Neuropsychiatry Clin Neurosci 2004;16:350–6.CrossRefGoogle ScholarPubMed
2.Kurisu, S, Sato, H, Kawagoe, T. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 2002;143:448–55.Google Scholar
3.Monterrubio Villar, J, Fernaández Bergés, D, Alzugaray Fraga, R, et al. ST elevation and tension pneumothorax. Rev Esp Cardiol 2000;53:467–70.Google Scholar
4.Mosseri, M, Eliakim, R, Mogle, P. Perforation of the esophagus mimicking myocardial infarction. Isr J Med Sci 1986;22:451–4.Google Scholar
5.Wang, K, Asinger, R, Marriott, H. ST-segment elevation in conditions other than acute myocardial infarction. N Engl J Med 2003;349:2128–35.Google Scholar
6.Mittal, SR, Maheshwari, M. Electrocardiographic changes in submassive pulmonary embolism. Indian Heart J 2005;57:80–3.Google ScholarPubMed
7.Rodher, M, Makropoulos, D, Turek, M, et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 2000;86:807–9.Google Scholar
8.Panos, R, Barish, R, Whye, D, et al. The electrocardiographic manifestations of acute pulmonary embolism. J Emerg Med 1988;6:301–7.Google Scholar
9.Antman, EM, Anbe, DT, Armstrong, PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004. Available at: http//www.acc.org/clinical/guidelines/stemi/index.pdf (accessed June 2010).Google Scholar
10.McConnell, MV, Solomon, SD, Rayan, ME, et al. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol 1996;78:469–73.Google Scholar
11.Casazza, F, Bongarzoni, A, Capozi, A, et al. Regional right ventricular dysfunction in acute pulmonary embolism and right ventricular infarction. Eur J Echocardiogr 2005;6:11–4.CrossRefGoogle ScholarPubMed