Open AccessThe dilemma of the “ischemic-looking” electrocardiogram: Pulmonary embolism or acute coronary syndrome?
Author(s) -
Paurush Ambesh,
Aditya Kapoor,
Sudeep Kumar,
Sunil K. Jain
Publication year - 2019
Publication title -
annals of cardiac anaesthesia/annals of cardiac anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.42
H-Index - 27
eISSN - 0974-5181
pISSN - 0971-9784
DOI - 10.4103/aca.aca_40_18
Subject(s) - medicine , acute coronary syndrome , chest pain , cardiology , pulmonary embolism , troponin , electrocardiography , radiology , myocardial infarction
Pulmonary embolism (PE) may be potentially fatal if not diagnosed and treated in time. Although specific electrocardiogram (ECG) findings often suggest the diagnosis of PE, occasionally, the ECG may mimic that of an acute coronary syndrome (ACS). We report an interesting case of a 45-year-old female presenting with sudden onset chest pain and shortness of breath with widespread ST depression in anterior precordial leads. Although initially treated and referred as a case of ACS, careful analysis of the ECG and subsequent echocardiography and computed tomography imaging confirmed the diagnosis of PE. Intensivists and cardiologists need to be aware that diagnostic dilemma between PE and ACS is not uncommon due to such "ischemic-looking" ECG as well as elevated troponin levels in both conditions. The use of multimodality imaging techniques is helpful in arriving at the correct diagnosis.