A potential diagnostic pitfall in ST elevation: Acute pulmonary embolism or ST-segment elevation myocardial
Bo Zheng1, Fei Bian1, Jingsen Li1
1Department of Cardiology, Binzhou Medical University Hospital, Binzhou City, Shandong, China.
Summary
Acute pulmonary embolism (APE) diagnosis is challenging due to nonspecific symptoms. This case highlights APE presenting with ST-elevation mimicking heart attack, but with a concurrent blocked artery.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Diagnostic Imaging
Background:
- Acute pulmonary embolism (APE) poses diagnostic challenges due to nonspecific symptoms, often leading to misdiagnosis as acute coronary syndrome.
- Electrocardiographic (ECG) abnormalities are common in APE patients.
- ST-segment elevation (STE) in specific ECG leads (V1-V4) can mimic ST-segment elevation myocardial infarction (STEMI) in APE.
Observation:
- A case of APE is presented with significant ST-segment elevation in leads V1-V4.
- This ECG pattern mimicked STEMI.
- Coronary angiography revealed normal coronary arteries in previously described cases of APE with STE.
Findings:
- The described case of APE presented with STE in V1-V4.
- Unlike previous reports, this patient also exhibited severe stenosis of the left anterior descending (LAD) artery.
Implications:
- This case expands the spectrum of APE presentations, particularly concerning ECG findings.
- It underscores the importance of considering APE even with concurrent coronary artery disease findings.
- Accurate diagnosis of APE requires a comprehensive approach integrating clinical, ECG, and imaging data.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
79
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
79
01:30Acute Coronary Syndrome I: Introduction
113
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
113
01:30Acute Coronary Syndrome III: Diagnostic Studies
41
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
41
01:27Myocarditis II: Clinical Features and Diagnostic Tests
41
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
41
01:29Pulmonary Embolism I: Introduction
177
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
177
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
68
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
68