| Abstrakt: |
Introduction:Diagnosing a pulmonary embolism (PE) can be challenging, especially when it presents as another “can’t miss” diagnosis like acute coronary syndrome. Although electrocardiogram (EKG) abnormalities can be seen in many PE presentations, rarely are ST elevations noted. We describe a case report of PE presenting as STEMI.Case presentation:A 71-year-old woman with hypertension, hyperlipidemia, type 2 diabetes mellitus, and morbid obesity presented to the emergency department with chest pain radiating to the jaw along with shortness of breath. On initial presentation her heart rate was 110 bpm, respiratory rate 40, 84% SpO2 on room air, and blood pressure 150/84 mmHg. EKG showed ST elevation in anterior leads V1-V2 and reciprocal changes of ST depression in lateral leads I, aVL, V5-V6. Serial troponins were elevated and she underwent left heart catheterization which showed non-obstructive coronary artery disease and hyperdynamic left ventricular function. Right heart catheterization (RHC) showed an elevated mean pulmonary artery pressure of 49 mmHg, and pulmonary artery pulsatility index was 2.2, suggestive of right ventricular dysfunction which prompted an urgent CT pulmonary angiogram and transthoracic echocardiogram. The CT revealed extensive pulmonary embolism and echocardiogram demonstrated dilated right ventricle with hypokinesis and akinetic right ventricular free wall. A left lower extremity ultrasound revealed deep vein thrombosis.Discussion:This patient depicts an uncommon presentation of acute PE masquerading as acute coronary syndrome. Her case was diagnostically challenging as her EKG findings were not consistent with those typically seen in acute PE. Review of the literature reveals only a handful of case reports of a PE appearing to be a STEMI. Although rare, clinicians should entertain the idea of PE when presented with ST elevation and no culprit lesion and a careful RHC may be useful in establishing diagnosis. |
