Case Report: Diffuse T wave inversions as initial electrocardiographic evidence in acute pulmonary embolism

Abstract

Acute pulmonary embolism (PE) is a life-threatening condition and is typically diagnosed by a combination of symptoms, clinical signs and imaging. Electrocardiogram may be helpful in diagnosis, and the most widely described pattern of occurrence is the so-called S 1Q 3T 3 pattern. Here, we describe the case of an African-American male who presented with typical chest pain, diffuse T wave inversions with serial troponin elevation. There was initial concern for Wellen's syndrome but was finally diagnosed as acute PE. This case underscores the necessity of vigilance and a lower threshold for PE work up even in patients presenting as acute coronary syndrome.

Acute Pulmonary Embolism Presenting With Angina and a Positive Cardiac Stress Test

“…S1Q3T pattern is often considered the pathognomonic EKG abnormality for acute PE [ 6 ]. Electrocardiographic ST segment elevations and new T wave inversions are also commonly seen, especially in massive PE patients [ 7 , 8 ]. Our patient had evidence of ST segment depressions on his nuclear stress test.…”