Key result
Catheter-directed thrombolysis rapidly reverses ST elevation and symptoms in STEMI-mimicking acute PE.
Why the study?
Acute pulmonary embolism presenting with ST-segment elevation and an upward T-wave is rare, with only a few cases reported to date.
Case Report (n=1)
Highlights that acute pulmonary embolism can present with ST-elevation and positive biomarkers mimicking STEMI, emphasizing the need for broad differential diagnosis in acute chest pain evaluation.
Consider pulmonary embolism in STEMI mimics; this case leaves open the role of catheter-directed thrombolysis.
Acute pulmonary embolism (APE) with ST-segment elevation and an upward T-wave is rare, and only a few cases have been reported to date. We herein present a case involving a man in his early 70s with an 8-hour history of dyspnea. Serial electrocardiography (ECG) demonstrated ST-segment elevation in leads V1 to V3 with an upward T-wave, laboratory tests revealed a high serum concentration of high-sensitivity cardiac troponin I, and signs of acute myocardial infarction were present. However, emergency coronary angiography revealed normal coronary arteries. A subsequent computed tomography scan of the pulmonary arteries showed findings consistent with APE. The patient's chest tightness was relieved after catheter-directed thrombolysis. Postoperative ECG showed that the ST-segment in leads V1 to V3 had fallen back and that the T-wave was inverted. The patient was discharged on rivaroxaban therapy. Clinically, the ECG findings of ST-segment elevation and an upward T-wave in APE can be easily misdiagnosed as acute myocardial infarction. Physicians should maintain clinical suspicion through risk stratification to identify APE.
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Yue et al. (2023) conducted a case report in Acute pulmonary embolism mimicking STEMI (n=1). Catheter-directed thrombolysis (urokinase) was evaluated on Symptom relief and ECG changes. Catheter-directed thrombolysis successfully resolved symptoms and reversed ST-segment elevation in a patient with acute pulmonary embolism mimicking a STEMI.
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