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Bilateral Lung Artery Embolization Mimicking an Acute Myocardial Infarction
Maria Paparoupa1, Razaz Aldemyati1,2, Myrto Theodorakopoulou1
1Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr.52, Hamburg 20246, Germany.
Case Reports in Medicine
|July 5, 2021
Summary
Massive pulmonary embolism can cause electrocardiogram changes mimicking heart attacks, posing a diagnostic challenge. Prompt diagnosis and treatment are crucial, but complications like electromechanical dissociation can still occur.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Massive pulmonary embolism (PE) frequently presents with nonspecific electrocardiographic (ECG) abnormalities.
- Distinguishing PE from acute myocardial infarction (MI) is critical in unstable patients.
Observation:
- An 80-year-old woman with severe respiratory insufficiency and hemodynamic instability showed ECG changes suggestive of MI, including ST-segment elevation.
- Echocardiography revealed right ventricular strain, raising suspicion for PE.
- Computed tomography confirmed massive PE, and thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) was initiated.
Findings:
- Despite initial stabilization, the patient developed electromechanical dissociation and died 30 hours post-treatment.
- ECG findings in massive PE can misleadingly suggest myocardial infarction.
Implications:
- Clinicians in emergency medicine and intensive care must consider massive PE in patients with MI-like ECG changes and hemodynamic instability.
- Early recognition and management of PE are vital, but vigilance for potential complications is necessary.
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