ECG FINDINGS IN PULMONARY EMBOLISM OR PSEUDO INFARCTION PATTERN
Keywords:
ECG finding, pulmonary embolism, pseudoinfarction pattern
Abstract
Introduction/objective The differential diagnosis of ST elevation includes 4 major conditions: MI, pericarditis, early repolarization syndrome, secondary changes, and other diagnoses such as pulmonary embolism (PE). Our goal is to acquaint the doctor with making the right decision.
Case report The 84-year-old patient called HMP because of chest pain and difficulty breathing. She was found lying flat, pale and sweaty, but currently. She had hip surgery, on fraxiparin therapy. BP 90/60mmHg, HR 115 / min, RR is 20 / min, SpO2 70%, normal frequency and vesiculary breahing. ECG: ST elevation in D2, D3, and AVF, with depression in D1, AVL, V2-6, as well as S1Q3T3.
Conclusion: Coronary angiography per se will not harm these patients, but delaying PE therapy can be fatal. Of great importance is ECG monitoring, where the regression of ECG changes, and the loss of Q tooth favors PE.
References
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2. Hanna EB, Glancy DL. ST-segment elevation: Differential diagnosis, caveats. Cleve Clin J Med. 2015;82(6):373-84.
3. Thomson D, Kourounis G, Trenear R, Messow CM, Hrobar P, Mackay A, et al. ECG in suspected pulmonary embolism. Postgrad Med J. 2019; 95(1119):12-17.
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5. Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM. Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism. Semin Intervent Radiol. 2018 ;35(2):92-98.
6. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 J21;41(4):543-603. .
7. Villablanca PA, Vlismas PP, Aleksandrovich T, Omondi A, Gupta T, Briceno DF, Garcia MJ, Wiley J. Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction. Vascular. 2019;27(1):90-97.
8. Radovanović N, Radosavljević-Radovanović M, Dobrić M, Antonijević N, Mitrović P. Akutni infarkt miokarda - pravovremenost i povezanost u zbrinjavanju bolesnika. Acta chirurgica iugoslavica.2016;63(2):9-13
9. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al, ESC Scientific Document Group, 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39 (2):119–177.
10. Arshad H, Khan RR, Khaja M. Case Report of S1Q3T3 Electrocardiographic Abnormality in a Pregnant Asthmatic Patient During Acute Bronchospasm. Am J Case Rep. 2017;18:110-113.
11. Goslar T, Podbregar M. Acute ECG ST-segment elevation mimicking myocardial infarction in a patient with pulmonary embolism. Cardiovasc Ultrasound. 2010;8:50.
12. Mistry A, Natarajan N, Hussain S, Vali Z. Unusual presentation of acute pulmonary embolus presenting with inferior ST elevation. BMJ Case Rep. 2018;2018:bcr2018226063.
13. Warner MJ, Tivakaran VS. Inferior Myocardial Infarction. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan
14. Hamed SA, Elhadad AF, Abdel-aal RF, Hamed EA. Cardiac Autonomic Function with Iron Deficiency Anemia. J Neurol Exp Neurosci. 2020; 6(2): 51-57.
2. Hanna EB, Glancy DL. ST-segment elevation: Differential diagnosis, caveats. Cleve Clin J Med. 2015;82(6):373-84.
3. Thomson D, Kourounis G, Trenear R, Messow CM, Hrobar P, Mackay A, et al. ECG in suspected pulmonary embolism. Postgrad Med J. 2019; 95(1119):12-17.
4. Uzelac B. Teorija elektrokardiografije, knjiga 1.Beograd: Uzelac B, 2019,str. 228.
5. Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM. Epidemiology, Pathophysiology, and Natural History of Pulmonary Embolism. Semin Intervent Radiol. 2018 ;35(2):92-98.
6. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 J21;41(4):543-603. .
7. Villablanca PA, Vlismas PP, Aleksandrovich T, Omondi A, Gupta T, Briceno DF, Garcia MJ, Wiley J. Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction. Vascular. 2019;27(1):90-97.
8. Radovanović N, Radosavljević-Radovanović M, Dobrić M, Antonijević N, Mitrović P. Akutni infarkt miokarda - pravovremenost i povezanost u zbrinjavanju bolesnika. Acta chirurgica iugoslavica.2016;63(2):9-13
9. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al, ESC Scientific Document Group, 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39 (2):119–177.
10. Arshad H, Khan RR, Khaja M. Case Report of S1Q3T3 Electrocardiographic Abnormality in a Pregnant Asthmatic Patient During Acute Bronchospasm. Am J Case Rep. 2017;18:110-113.
11. Goslar T, Podbregar M. Acute ECG ST-segment elevation mimicking myocardial infarction in a patient with pulmonary embolism. Cardiovasc Ultrasound. 2010;8:50.
12. Mistry A, Natarajan N, Hussain S, Vali Z. Unusual presentation of acute pulmonary embolus presenting with inferior ST elevation. BMJ Case Rep. 2018;2018:bcr2018226063.
13. Warner MJ, Tivakaran VS. Inferior Myocardial Infarction. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan
14. Hamed SA, Elhadad AF, Abdel-aal RF, Hamed EA. Cardiac Autonomic Function with Iron Deficiency Anemia. J Neurol Exp Neurosci. 2020; 6(2): 51-57.
Published
2022/01/10
Section
Case report
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