Key result
Acute PE can mimic STEMI due to paradoxical coronary embolism via right-to-left intra-atrial communication.
Case Report (n=1)
No
Highlights paradoxical coronary embolism as a rare but important mechanism for ST-elevation mimicking myocardial infarction in acute pulmonary embolism.
Clinicians should consider intra-atrial shunts in PE with STEMI-like ECG; single case leaves open prevalence and management.
Pulmonary embolism is a common cardiovascular emergency, but it is still often misdiagnosed due to its unspecific clinical symptoms. Elevated troponin concentrations are associated with greater morbidity and mortality in patients with pulmonary embolism. Right ventricular ischemia due to increased right ventricular afterload is believed to be underlying mechanism of elevated troponin values in acute pulmonary embolism, but a paradoxical coronary artery embolism through opened intra-atrial communication is another possible explanation as shown in our case report.
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Goslar et al. (2010) conducted a case report in Pulmonary embolism (n=1). Pulmonary embolism with paradoxical coronary embolism was evaluated. Acute pulmonary embolism can present with ST-segment elevation mimicking myocardial infarction due to paradoxical coronary artery embolism through a right-to-left intra-atrial communication.
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