Diagnosing acute pulmonary embolism masquerading as inferior myocardial infarction

Zhong-qun, Zhan; Chong-quan, Wang; Wang, Zhixiao

doi:10.1016/j.ajem.2015.01.036

Cited by 5 publications

(2 citation statements)

References 9 publications

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“…In the acute setting, patients with right ventricular injury pattern may easily be misdiagnosed as an acute myocardial infarction. As shown in the literature (18), some APE patients may have a ST elevation in the inferior leads, mimicking ST segment elevation myocardial infarction. It was speculated that right ventricular strain may cause trans-mural ischemia, resulting in ST elevation in the inferior leads.…”

Section: Discussionmentioning

confidence: 84%

Akut Pulmoner Embolili Hastalarda R Dalga Pik Zamanının Tanısal Öngörücü Değeri

Karabağ¹,

Çınar²,

Çağdaş³

et al. 2018

Osmangazi̇ Journal of Medicine

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This study aimed to investigate the diagnostic predictive value of R wave peak time (RWPT) in patients admitted to the emergency department with a preliminary diagnosis of acute pulmonary embolism (APE). Computerized tomographic pulmonary angiography (CTPA) was performed in 74 consecutive patients with suspected APE, and of these 66 patients with appropriate electrocardiogram (ECG) and CTPA images composed the study population.By using CTPA, APE was confirmed in 27 patients. While the atrial arrhythmia, right axis deviation, complete or incomplete right bundle branch block, prominent S wave in the lead DI, S1Q3T3 pattern, and RWPT in the lead DIII (40±11 vs. 31±13 ms) were statistically different in patients with APE compared to those without APE (p<0.05, for all), the other ECG findings were similar. Multivariate analysis revealed that RWPT in the lead DIII (odds ratio: 14.959, 95% confidence interval: 1.811-123.582, p=0.012) was found to be an independent predictor of APE. A receiver operating characteristic analysis was drawn to show the best cutoff value of the RWPT in the lead DIII to predict APE was ≥40 ms with 48.1% sensitivity and 87.2 % specificity (area under curve (AUC): 0.718; 95% CI: 0.593-0.843; p=0.003).The present study demonstrated that the RWPT in the lead DIII may have diagnostic predictive value for APE. In addition, it may be useful in electrocardiographic signs for the diagnosis of APE.

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Section: Discussionmentioning

confidence: 84%

Akut Pulmoner Embolili Hastalarda R Dalga Pik Zamanının Tanısal Öngörücü Değeri

Karabağ¹,

Çınar²,

Çağdaş³

et al. 2018

Osmangazi̇ Journal of Medicine

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“…Speci c regional patterns, like the inferior pattern seen in our patient, are rare (text box 2). Regional pericarditis 14 Severe hypocalcaemia 15 Acute pancreatitis 16 Pulmonary embolus 17…”

Section: Discussionmentioning

confidence: 99%

The Way to a Man’s Heart Is Through His Stomach: a Case of Myocardial Infarction Mimic and Pseudo-tamponade in a Polytrauma Patient.

Brun

Pearson

et al. 2021

Preprint

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Background: There exists a therapeutic conflict between haemorrhage control and prevention of thromboembolic events following polytrauma and complications are not uncommon. Such opposing therapies can result in unexpected pathophysiology and there is a real risk of misdiagnosis resulting in harm. This case presents a previously unreported complication of prevention and management of thromboembolism- STEMI (ST elevation myocardial infarction) and tamponade mimic secondary to retroperitoneal haematoma.Case presentation: We present a 50-year-old male polytrauma patient who following treatment for presumed pulmonary embolus demonstrated classical clinical findings of myocardial infarction and pericardial tamponade secondary to a retroperitoneal haematoma. This is an event not previously reported in the literature. The risk of adverse outcome by management along the standard lines of STEMI (ST elevation myocardial infarction) was averted through awareness for alternative aetiology via a multi-team approach which resulted in percutaneous drainage of the haematoma and complete resolution of symptoms.Conclusions: This manuscript highlights the therapeutic conflict between haemorrhage control and prevention of thromboembolic events in critically injured, the importance of high index of suspicion in this patient cohort and the benefits of multidisciplinary decision making in the complex patient through a not previously published pathophysiologic phenomenon.

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