Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Diagnostic Trap
Ayesha Siddiqa1, Asim Haider1, Abhishrut Jog1
1Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
The American Journal of Case Reports
|November 28, 2020
Summary
Pulmonary embolism (PE) can mimic ST-elevation myocardial infarction (STEMI) on EKGs, challenging diagnosis. Early suspicion and risk stratification are crucial for identifying PE presenting as STEMI.
Area of Science:
- Cardiology
- Pulmonology
- Emergency Medicine
Background:
- Pulmonary embolism (PE) diagnosis is challenging due to variable clinical presentations.
- Electrocardiograms (EKGs) show nonspecific patterns in PE, rarely ST-segment elevation.
Observation:
- A middle-aged male with obesity presented with EKG findings suggestive of ST-elevation myocardial infarction (STEMI).
- Cardiac catheterization revealed patent coronary arteries, while chest CTA showed bilateral sub-massive pulmonary embolism.
Findings:
- Pulmonary embolism can present with EKG abnormalities and biomarkers mimicking acute coronary syndrome, including STEMI.
- ST-segment elevation is an exceedingly rare EKG finding in PE.
Implications:
- Physicians must maintain high clinical suspicion for PE in STEMI-like presentations.
- Risk stratification and bedside echocardiography are vital for diagnosing PE in these rare cases.
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