Ladage Varvara, Jones Miciah, Ahmad Faheem, Plamoottil Cherian, Misek Ryan, Alexander-Anyaogu Nicole
Midwestern University Chicago College of Osteopathic Medicine, Department of Emergency Medicine, Downers Grove, Illinois.
Franciscan Health Olympia Fields, Department of Cardiology, Olympia Fields, Illinois.
Clin Pract Cases Emerg Med. 2020 Nov;4(4):660-663. doi: 10.5811/cpcem.2020.7.48421.
While the electrocardiogram (ECG) for pulmonary embolism typically shows tachycardia or evidence of right heart strain, it can demonstrate ischemic changes similar to acute coronary syndrome.
The patient in this case presented with syncope, chest pain, and an ECG showing an anterior acute myocardial infarction (AMI) without evidence of right heart strain. His cardiac catheterization showed no coronary artery occlusions, but some signs of pulmonary embolism (PE), which was confirmed on computed tomography angiography of the chest.
This case demonstrates that PE should be high on the differential for AMI and describes an uncommonly encountered mimic for classic ST-elevation myocardial infarction ECG changes. Further diagnostics to confirm the diagnosis should be obtained when indicated.
虽然肺栓塞的心电图(ECG)通常显示心动过速或右心劳损的迹象,但它也可能表现出与急性冠状动脉综合征相似的缺血性改变。
本病例中的患者出现晕厥、胸痛,心电图显示前壁急性心肌梗死(AMI),无右心劳损迹象。他的心脏导管检查显示没有冠状动脉闭塞,但有一些肺栓塞(PE)的迹象,胸部计算机断层血管造影证实了这一点。
该病例表明,在鉴别诊断AMI时应高度怀疑PE,并描述了一种罕见的经典ST段抬高型心肌梗死心电图改变的模仿情况。如有指征,应进行进一步诊断以确诊。