A Rare Case of Pulmonary Emboli Presenting With ST Elevation on ECG

Gheith, Zaid; Alqam, Bilal; Jagana, Rajani

doi:10.7759/cureus.29249

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…Despite being rare, it has been shown that PE can present itself with ST-segment elevation, mimicking STEMI. The most commonly affected leads are V1 to V4, as was seen in this case [ 6 , 7 , 14 , 15 , 16 , 17 ], but inferior lead involvement has also been reported [ 18 ]. The gold standard diagnostic test for PE is computed tomography pulmonary angiography; however, alternatively, invasive pulmonary angiography can confirm the diagnosis [ 3 ].…”

Section: Discussionmentioning

confidence: 60%

ST-Segment Elevation: An Unexpected Culprit

Sá Couto,

Alexandre,

Costa

et al. 2023

JCDD

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The clinical presentation of pulmonary embolism (PE) and acute coronary syndrome can be similar. We report a case of a patient presenting with antero-septal ST-segment elevation after cardiac arrest, found to have acute-PE-mimicking ST-segment elevation myocardial infarction (STEMI), treated with aspiration thrombectomy and catheter-directed thrombolysis (CDT). A 78-year-old man was admitted with dyspnea, chest pain and tachycardia. During evaluation, cardiac arrest in pulseless electrical activity was documented. Advanced life support was started immediately. ECG post-ROSC revealed ST-segment elevation in V1–V4 and aVR. Echocardiography showed normal left ventricular function but right ventricular (RV) dilation and severe dysfunction. The patient was in shock and was promptly referred to cardiac catheterization that excluded significant CAD. Due to the discordant ECG and echocardiogram findings, acute PE was suspected, and immediate invasive pulmonary angiography revealed bilateral massive pulmonary embolism. Successful aspiration thrombectomy was performed followed by local alteplase infusion. At the end of the procedure, mPAP was reduced and blood pressure normalized allowing withdrawal of vasopressor support. Twenty-four-hour echocardiographic reassessment showed normal-sized cardiac chambers with preserved biventricular systolic function. Bedside echocardiography in patients with ST-segment elevation post-ROSC is instrumental in raising the suspicion of acute PE. In the absence of a culprit coronary lesion, prompt pulmonary angiography should be considered if immediately feasible. In these cases, CDT and aspiration in high-risk acute PE seem safe and effective in relieving obstructive shock and restoring hemodynamics.

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