Pulmonary embolism associated with acute ST-segment elevation myocardial infarction

Pulmonary embolism (PE) is a potentially fatal condition that presents with shortness of breath and chest pain. Although an electrocardiogram (ECG) may show changes associated with PE, ST elevation mimicking ST elevation myocardial infarction is not common in patients with acute PE. This presentation documents the case of a 67-year-old man who presented to the emergency department with dyspnea and chest pain. ECG data indicated anterior septal myocardial infarction and acute ischemia of the lower parts of the left ventricle. Cardiac catheterization did not reveal atherosclerotic lesions of the coronary arteries, but revealed an anomaly in the filling of the right coronary artery with embolic masses. Further examination of the patient revealed massive bilateral pulmonary embolism. In this presentation, we emphasize the need to evaluate patients with PE who present with chest pain, dyspnea, or both, even when ECG findings suggest a cardiac etiology. We also present a brief discussion of possible mechanisms for ST elevation in pulmonary embolism