Key result
Acute PE mimics ACS in a patient with chronic coronary syndrome presenting with syncope.
Why the study?
Pulmonary embolisms share clinical features with ACS, including ECG abnormalities and elevated troponin, frequently leading to misdiagnoses in emergency situations.
Case Report (n=1)
This case highlights the importance of recognizing pulmonary embolism in patients presenting with syncope, elevated troponin, and ECG changes mimicking acute coronary syndrome to prevent misdiagnosis and delayed treatment.
May prompt consideration of pulmonary embolism in syncope with ACS-like features; case report leaves open need for prospective validation.
BACKGROUND: Pulmonary embolisms (PEs) exhibit clinical features similar to those of acute coronary syndrome (ACS), including electrocardiographic abnormalities and elevated troponin levels, which frequently lead to misdiagnoses in emergency situations. CASE PRESENTATION: Here, we report a case of PE coinciding with chronic coronary syndrome in which the patient's condition was obscured by symptoms mimicking ACS. A 68-year-old female with syncope presented to the hospital. Upon admission, she was found to have elevated troponin levels and an electrocardiogram showing ST-segment changes across multiple leads, which initially led to a diagnosis of ACS. Emergency coronary arteriography revealed occlusion of the posterior branches of the left ventricle of the right coronary artery, but based on the complexity of the intervention, the occlusion was considered chronic rather than acute. On the 3rd day after admission, the patient experienced recurrent chest tightness and shortness of breath, which was confirmed as acute PE by emergency computed tomography pulmonary angiography. Following standardized anticoagulation treatment, the patient improved and was subsequently discharged. CONCLUSIONS: This case report highlights the importance of recognizing the nonspecific features of PE. Clinicians should be vigilant when identifying other clinical features that are difficult to explain accompanying the expected disease, and it is necessary to carefully identify the causes to prevent missed diagnoses or misdiagnoses.
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Chen et al. (2024) conducted a case report in Pulmonary embolism and chronic coronary syndrome (n=1). Pulmonary embolism masquerading as acute coronary syndrome was evaluated. A 68-year-old female with chronic coronary syndrome presented with syncope and clinical features mimicking acute coronary syndrome, but was ultimately diagnosed with acute pulmonary embolism.
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