Why the study?
ST-segment elevation on ECG may rarely occur in acute pulmonary thromboembolism, posing a diagnostic challenge that can lead to inappropriate or delayed management.
Case Report (n=1)
No
This case report highlights that massive acute pulmonary thromboembolism can rarely present with inferior and lateral ST-segment elevation mimicking myocardial infarction, emphasizing the critical role of bedside echocardiography in haemodynamically unstable and hypoxaemic patients to ensure timely thrombolysis.
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Echocardiography may aid differentiation of massive PE from inferior STEMI in shock; extends case reports but leaves generalizability open.
ST-segment elevation on electrocardiography (ECG) is classically associated with acute myocardial infarction but may rarely be seen in acute pulmonary thromboembolism (PTE). Such presentations pose a significant diagnostic challenge and may lead to inappropriate or delayed management. We report the case of a 44-year-old man who presented with acute chest tightness, severe hypoxaemia, shock, and ECG changes suggestive of inferior wall myocardial infarction. Subsequent evaluation revealed massive PTE with right ventricular (RV) dysfunction. The patient improved following systemic thrombolysis. This case highlights the importance of considering acute PTE in the differential diagnosis of ST-segment elevation, particularly in the presence of hypoxaemia and RV strain and discusses the possible pathophysiological mechanisms underlying these ECG changes.
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S et al. (2026) conducted a case report in High-risk acute pulmonary thromboembolism presenting with ST-segment elevation mimicking inferior wall myocardial infarction (n=1). Systemic thrombolysis with Tenecteplase and unfractionated heparin was evaluated on Clinical improvement, haemodynamic stabilisation, and resolution of hypoxaemia.
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