Acute Pulmonary Embolism With Multiple ST-Segment Elevations in Anterior and Inferior Leads: A Case Report

Acute pulmonary embolism (APE) is a common and potentially life-threatening cardiovascular emergency. Although APE typically presents with nonspecific electrocardiogram (ECG) abnormalities, a rare but critical presentation may mimic ST-segment elevation myocardial infarction. We report a case of APE with multiple ST-segment elevations in the anterior and inferior leads.

A 74-year-old man presented with chest tightness and dyspnea. His initial ECG revealed sinus tachycardia with ST-segment elevation in Leads III, aVF, and V1-V4, along with T-wave inversion and pathological Q waves. He did not report typical ischemic chest pain. Cardiac troponin I was 0.43 ng/mL on admission and peaked at 0.84 ng/mL over the next 2 days. Plasma D-dimer was markedly elevated at 4.59 mg/L. Deep vein thrombosis was detected in the left posterior tibial vein, and echocardiography showed mild pulmonary hypertension without left ventricular regional wall motion abnormalities. Emergency CT pulmonary angiography confirmed multiple thromboemboli in both the left and right pulmonary arteries. The patient was diagnosed with APE, treated with intravenous heparin followed by oral anticoagulation, and discharged after 9 days of treatment.

APE should be considered in the differential diagnosis of patients presenting with ST-segment elevation. Awareness of the ECG changes associated with APE and early diagnostic intervention can help prevent misdiagnosis and ensure timely treatment.