Acute pulmonary embolism can present with ST-segment elevation in right precordial leads, mimicking right ventricular myocardial infarction.
Consider acute PE in right precordial ST elevation mimicking RV MI; this case report leaves open prevalence and diagnostic algorithms.
A 58-year-old male presented with sudden onset of chest pain and breathlessness with hypotension. Electrocardiography demonstrated sinus tachycardia, right bundle branch block (RBBB) and ST-segment elevation in V1 and right precordial leads. These findings were suggestive of right ventricular myocardial infarction (RVMI). However, echocardiography revealed a large clot in main pulmonary artery with severe right ventricular dysfunction and no wall motion abnormality. Coronary angiogram demonstrated the normal left and right coronary system. Pulmonary angiogram revealed clots in right side branch pulmonary arteries. ST-segment elevation in right precordial leads is a rare finding in acute pulmonary embolism that mimics RVMI.
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Panneerselvam et al. (2011) studied this question.
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