McConnell's Sign in an RV Infarct: A Case Report

McConnell's sign on point-of-care ultrasound (POCUS) has traditionally been associated with acute pulmonary embolism (PE). However, current evidence suggests that McConnell's sign may not be as specific as commonly thought.

We present the case of an 85-year-old gentleman presenting to the emergency department (ED) with clinical features and ECG findings consistent with acute right ventricular myocardial infarction (RVMI). POCUS in the ED revealed McConnell's sign. Nevertheless, the patient was appropriately referred for percutaneous coronary intervention (PCI) to treat RVMI.

Had the treating team assumed that McConnell's sign was specific for PE, the patient might have been managed inappropriately, critically delaying coronary reperfusion through PCI. We argue that clinical teaching and guidelines should have greater emphasis on contextualising McConnell's sign with the clinical presentation in order to improve patient outcomes when making time-sensitive decisions. Additionally, the relationship between RV NSTEMI and McConnell's sign is yet to be explored in the available literature, and further research into this area could greatly improve diagnostic differentiation in the absence of regional ischaemia on ECG.