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Asymptomatic pulmonary embolus masquerading as acute anteroseptal myocardial infarction

Published online by Cambridge University Press:  11 May 2015

Jeanne Noble  and
Amandeep Singh
Jeanne Noble*
Affiliation:
Department of Emergency Medicine, University of California, San Francisco, CA
Amandeep Singh
Affiliation:
Department of Emergency Medicine, Alameda Country Medical Center, Highland Hospital, Oakland, CA
*
Department of Emergency Medicine, University of California, San Francisco, 505 Parnassus Avenue, Room L138, San Francisco, CA 94143-0208; Jeanne_noble@yahoo.com

Abstract

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Pulmonary embolism (PE) is an uncommon and often overlooked cause of ST-segment elevation on the electrocardiogram (ECG). Emergent echocardiography has been cited as a means to rapidly distinguish acute myocardial infarction from PE. However, both of these conditions can present with focal wall motion abnormalities. We report a case of a 51-year-old asymptomatic male who presented to our emergency department with anterior ST-segment elevation and right-heart strain on an ECG. The clinical diagnosis of ST elevation myocardial infarction was in doubt, and an echocardiogram was obtained while the patient was in the emergency department. Although a focal area of hypokinesia was observed on echocardiography, cardiac catherization did not demonstrate any evidence of acute coronary occlusion. A computed tomographic angiogram of the chest was subsequently obtained, which demonstrated evidence of submassive pulmonary emboli. Our case highlights the limited utility of emergent echocardiography in cases of ST-segment elevation.

Keywords

embolusinfarctionmyocardialpulmonary
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 1 , January 2011 , pp. 62 - 65
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

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