Key result
Bedside echocardiography identifies pulmonary embolism mimicking STEMI, avoiding unnecessary invasive coronary angiography.
Why the study?
Cocaine use is associated with both myocardial infarction and pulmonary embolism, and pulmonary embolism can mimic ST-elevation myocardial infarction, complicating diagnosis and management.
Case Report (n=1)
No
Point-of-care echocardiography is a crucial bedside tool in distinguishing acute pulmonary embolism from STEMI in patients presenting with chest pain and ST-segment elevation.
Bedside echocardiography may avert unnecessary catheterization in select cocaine users with suspected STEMI; leaves open prospective validation of diagnostic algorithms.
Cocaine has been linked to both myocardial infarction (MI) and pulmonary embolism (PE), with the latter occasionally mimicking acute coronary syndrome. We report a 54-year-old man with polysubstance abuse who was found unresponsive and revived with naloxone. He developed chest pain with electrocardiogram showing ST-segment elevation in V2-V3 and elevated troponin, suggestive of anteroseptal ST-elevation MI (STEMI). Bedside echocardiography revealed right ventricular dilation and dysfunction without left ventricular abnormalities, prompting computed tomography angiography (CTA), which demonstrated large bilateral pulmonary emboli with right heart strain. He was anticoagulated and later discharged on a direct oral anticoagulant; coronary angiography revealed only mild nonobstructive disease. This case underscores the diagnostic challenge of distinguishing PE from STEMI in patients with cocaine use and highlights the utility of point-of-care echocardiography in avoiding unnecessary invasive procedures. Clinicians should consider PE in the differential diagnosis of chest pain with ST elevation.
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Reddy et al. (2026) conducted a case report in Pulmonary embolism mimicking STEMI (n=1). Cocaine exposure was evaluated. A patient presenting with suspected anteroseptal STEMI was found to have cocaine-associated bilateral pulmonary emboli, highlighting the utility of bedside echocardiography in avoiding unnecessary invasive coronary angiography.
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