Acute Pulmonary Embolism Presenting With Angina and a Positive Cardiac Stress Test

Area of Science:

• Cardiology
• Pulmonology
• Diagnostic Imaging

Background:

• Acute pulmonary embolism (PE) is a critical condition with high mortality if not promptly diagnosed and treated.
• Electrocardiogram (EKG) findings like sinus tachycardia, S1Q3T3 pattern, and right ventricular strain are associated with PE but lack consistent sensitivity.
• Current diagnostic gold standards include CT angiography and V/Q scans.

Observation:

• A patient presented with symptoms suggestive of angina, including EKG changes during a stress test.
• Coronary angiography revealed obstructive coronary artery disease necessitating revascularization.
• Subsequent investigations uncovered a significant saddle pulmonary embolism.

Findings:

• The initial presentation mimicked cardiac ischemia, leading to coronary angiography.
• The pulmonary embolism was discovered after initial cardiac intervention, indicating a complex diagnostic challenge.
• The patient ultimately required pulmonary thrombectomy for the saddle PE.

Implications:

• This case underscores the importance of considering pulmonary embolism even with atypical presentations that mimic other conditions.
• Recognizing the limitations of EKG in diagnosing PE is crucial for timely and appropriate diagnostic workups.
• Integrated diagnostic approaches are vital for managing patients with overlapping cardiovascular and pulmonary emergencies.