Although he had a history of coronary artery disease, the chest discomfort differed from his typical angina. He described substantial midsternal chest pain and shortness of breath on awakening. The patient stated that he had no prodrome and was unaware as to how long he was unconscious. Report of CaseĪ 57-year-old man presented to the emergency department after he had a syncopal episode while at home alone. Abbreviations: S1Q3, prominence of the S wave in lead I and the Q wave in lead III S1Q3T3, prominence of the S wave in lead I, Q wave in lead III, and T wave in lead III. This figure was adapted from Electrocardiography in Clinical Practice: Adult and Pediatric. Typical electrocardiogram changes associated with pulmonary embolism. In addition, we review the changes in ECG results that are typically associated with PE and summarize the theory of ST-segment elevation in such cases. However, diagnostic testing revealed a large bilateral PE. The present report describes a man who demonstrated dramatic and dynamic ST-segment elevation suggestive of anteroseptal AMI. 1 On rare occasions, ST-segment elevation, which can indicate anteroseptal acute myocardial infarction (AMI), is associated with acute PE. Sinus tachycardia, complete or incomplete right bundle-branch block, the S1Q3T3 pattern (prominence of the S wave in lead I, Q wave in lead III, and T wave in lead III), and ST-segment depression in the precordial leads are among the most common ECG findings characteristic of this condition ( Figure 1). Electrocardiograms (ECGs) are typically used to diagnose PE in patients. A brief discussion of the current theories of ST-segment elevation in the setting of PE is also included.Īcute pulmonary embolism (PE), common in patients presenting with chest pain and dyspnea, can be lethal, particularly if the condition is not diagnosed. The present report emphasizes that physicians must investigate PE in all patients presenting with chest pain, dyspnea, or both, even in the face of ECG changes that are suggestive of a cardiac etiology. On further examination, the patient was found to have a massive bilateral PE. Findings from an ECG suggested anteroseptal AMI however, cardiac catheterization indicated that the patient did not have critical ischemic heart disease. The current report documents the case of a 57-year-old man who presented to the emergency department with chest pain. Although electrocardiograms (ECGs) typically demonstrate abnormalities associated with PE, ST-segment elevation, which can indicate anteroseptal acute myocardial infarction (AMI), has-on rare occasions-been noted on ECGs of patients with acute PE. Pulmonary embolism (PE) is a potentially lethal condition that presents in patients with chest pain or shortness of breath.
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