Siddiqa Ayesha, Haider Asim, Jog Abhishrut, Yue Bing, Krim Nassim R
Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
Department of Cardiology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
Am J Case Rep. 2020 Nov 28;21:e927923. doi: 10.12659/AJCR.927923.
BACKGROUND The clinical presentation of pulmonary embolism (PE) is highly variable, ranging from no symptoms to shock or sudden death, often making the diagnosis a challenge. An electrocardiogram (EKG) is not a definitive diagnostic tool; however, it can alter the clinical suspicion of acute PE. PE has nonspecific electrocardiographic patterns ranging from a normal EKG in almost 33% of patients to sinus tachycardia, S1Q3T3 pattern (McGinn-White Sign), right axis deviation, and incomplete right bundle branch block (RBBB). ST-segment elevation associated with PE is exceedingly rare, and to date, only a few cases have been reported. CASE REPORT We present a case of a middle-aged male patient with no medical comorbidities other than obesity, who presented with initial symptoms and EKG findings concerning an ST-elevation myocardial infarction (STEMI). He was later found to have rather patent coronary arteries on cardiac catheterization but bilateral sub-massive pulmonary embolism on computed tomography angiogram (CTA) of the chest. CONCLUSIONS The differential diagnosis of STEMI is broad, including, but not limited to, Prinzmetal's angina, takotsubo cardiomyopathy, Brugada syndrome, left ventricular aneurysm, hypothermia, hyperkalemia, and acute pericarditis. Pulmonary embolism may present with abnormal EKG and biomarkers that appear to be an acute coronary syndrome, even STEMI. Physicians must maintain a high index of clinical suspicion through risk stratification to identify PE in these settings, as the frequency of such an occurrence is extremely low. A bedside echocardiogram can be an invaluable diagnostic tool in such cases.
肺栓塞（PE）的临床表现高度多变，从无症状到休克或猝死，这常常使诊断成为一项挑战。心电图（EKG）并非确定性诊断工具；然而，它可改变对急性PE的临床怀疑。PE具有非特异性心电图模式，从近33%的患者心电图正常到窦性心动过速、S1Q3T3模式（麦金-怀特征）、电轴右偏和不完全性右束支传导阻滞（RBBB）。与PE相关的ST段抬高极为罕见，迄今为止，仅报道了少数病例。病例报告：我们报告一例中年男性患者，除肥胖外无其他合并症，最初表现出与ST段抬高型心肌梗死（STEMI）相关的症状和EKG表现。后来心脏导管检查发现其冠状动脉相当通畅，但胸部计算机断层血管造影（CTA）显示双侧亚大块肺栓塞。结论：STEMI的鉴别诊断范围广泛，包括但不限于变异型心绞痛、应激性心肌病、 Brugada综合征、左心室室壁瘤、低温、高钾血症和急性心包炎。肺栓塞可能表现出异常的EKG和生物标志物，看似急性冠状动脉综合征，甚至是STEMI。在这些情况下，医生必须通过风险分层保持高度的临床怀疑，以识别PE，因为这种情况的发生率极低。床边超声心动图在这类病例中可能是一种非常有价值的诊断工具。
