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Cite this article
A Review of Electrocardiography in Pulmonary Embolism: Recognizing Pulmonary Embolus Masquerading as ST-Elevation Myocardial Infarction
1 Department of Hematology/Oncology, MD Anderson Cancer Center, Houston, TX
2 Department of Cardiology, Albert Einstein Medical Center, Philadelphia, PA
3 Einstein Institute for Heart and Vascular Health, Albert Einstein Medical Center, and Jefferson Medical College, Philadelphia, PA
Rev. Cardiovasc. Med. 2011, 12(3), 157–163; https://doi.org/10.3909/ricm0584
Published: 30 September 2011
A 64-year-old woman with hypertension and diabetes presented with acute shortness of breath and left-sided chest discomfort. Electrocardiogram (ECG) demonstrated Q waves, coved ST-segment elevations, and T-wave inversions in leads V1-V4, suggesting acute anterior ST-elevation myocardial infarction (STEMI). Catheterization revealed nonocclusive coronary artery disease with elevated pulmonary and right heart pressures, confirmed by echocardiography. Ventilation perfusion scan was deemed high probability for pulmonary embolism (PE). Treatment for a submassive PE was initiated and ECG changes resolved by discharge. This case exemplifies similarities in clinical presentation of PE and acute STEMI. The presence of Q waves in anterior leads with coved ST-elevation after PE has not been described previously. We review the differential diagnosis of ST elevation and the assorted spectrum of ECG changes seen in PE.
Acute myocardial infarction