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V1-V2-V3-V4 T wave inversion: left or right ventricle?
Antonio Mirijello1, Roberto Pola, Luisa Saviano
1Department of Internal Medicine, Catholic University of Rome, Roma, Italy.
BMJ Case Reports
|October 11, 2013
Summary
An elderly patient with Alzheimer's disease initially diagnosed with myocardial infarction due to ECG changes and elevated troponin-T was found to have a pulmonary embolism (PE). This case highlights misleading ECG findings in PE.
Area of Science:
- Cardiology
- Pulmonology
- Emergency Medicine
Background:
- Alzheimer's disease patients can present with atypical symptoms.
- Electrocardiogram (ECG) abnormalities and elevated troponin-T levels can mimic myocardial infarction.
- Pulmonary embolism (PE) is a critical diagnosis that requires prompt identification.
Observation:
- An 84-year-old woman with Alzheimer's disease presented with severe dyspnoea.
- Initial ECG showed anterior T wave inversion and troponin-T was elevated, suggesting anterior non-ST elevation myocardial infarction.
- Further review and diagnostic tests revealed a confirmed diagnosis of PE.
Findings:
- The patient's clinical presentation and initial investigations were misleading.
- Echocardiography and contrast-enhanced CT scan confirmed pulmonary embolism.
- ECG findings, typically indicative of myocardial infarction, can be caused by PE.
Implications:
- This case underscores the importance of considering pulmonary embolism as a differential diagnosis in patients with atypical presentations.
- Recognizing misleading ECG changes in PE is crucial for accurate and timely diagnosis.
- Awareness of these electrocardiographical changes can prevent misdiagnosis and improve patient outcomes.
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