Key result
Angina symptoms and positive stress test reveal concurrent obstructive CAD and saddle PE requiring thrombectomy.
Why the study?
Acute PE is commonly missed, and prompt diagnosis and anticoagulation are vital for reducing mortality, yet common EKG findings are only modestly sensitive.
Case Report (n=1)
No
Acute pulmonary embolism can present with angina-like symptoms and positive stress test EKG changes, potentially masking or coexisting with obstructive coronary artery disease.
PE may mimic CAD on stress testing; case report leaves open coexistence frequency and need for broader evaluation.
Acute pulmonary embolism (PE) is a commonly missed clinical entity. Prompt diagnosis of PE and the initiation of anticoagulation therapy is vital for the reduction of patient mortality. Recognizing initial electrocardiogram manifestations can aid rapid diagnosis and prompt management. The most common EKG findings associated with PE are sinus tachycardia, S1Q3T3 pattern, presence of T wave inversions in V1-V3 associated with the presence of right ventricular (RV) dysfunction, and right bundle branch block. These findings, while specific, are modestly sensitive and not always present. The gold standard of diagnosis is computerized tomographic angiography and ventilation and perfusion (V/Q). Here we present a patient who presented with symptoms mimicking angina with EKG changes in his stress test, prompting coronary angiography, which showed obstructive coronary artery disease requiring revascularization. Subsequently, further evaluation revealed a saddle pulmonary embolism that necessitated pulmonary thrombectomy.
No takes yet. Share an insight, caveat, or question.
Waheed et al. (2020) conducted a case report in Acute pulmonary embolism (n=1). Coronary angiography and pulmonary thrombectomy was evaluated. A patient presenting with angina-like symptoms and a positive stress test was diagnosed with both obstructive coronary artery disease and a saddle pulmonary embolism requiring thrombectomy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: