Unusual presentation of acute pulmonary embolus presenting with inferior ST elevation

A 67-year-old woman presented with a 6-hour history of dull, inspiratory chest pain and shortness of breath  that had subsided on arrival to hospital. She denied any history of coronary artery disease and had no veno-thromboembolic risk factors. Her semirecumbent blood pressure was 94/50 mm Hg, and oxygen saturations were 98% on room air. Chest X-ray was unremarkable. The initial ECG demonstrated sinus tachycardia only. She later developed further chest pain with dynamic 1 mm ST segment elevation in lead III (figure 1A). In addition, there was ECG evidence of S1Q3T3 pattern, and troponin was 3444 ng/mL. An urgent bedside transthoracic echocardiogram supported a diagnosis of acute pulmonary embolus (APE) as opposed to acute ST elevation myocardial infarction (figure 1B–D). It showed a …