title: Left ventricular myocardial injury and syncope due to pulmonary embolism in a soldier: normal coronaries and novel pathologic electrocardiogram signs.
abstract: OBJECTIVE
  We present a soldier with a pulmonary embolism presenting with syncope during an ischemic stress test, subsequently found to have normal coronary arteries (CA).
  
  
  METHODS
  A 49-year-old soldier had 3 months history of exertional chest pain, shortness of breath, syncope, and malaise. He passed out during a stress echocardiogram and had a positive troponin level. A subsequent cardiac catheterization revealed normal CA but with mild hypokinesis of the distal anterior wall with a left ventricular ejection fraction of 44%. A subsequent nuclear ventilation-perfusion scan was consistent with bilateral pulmonary embolism.
  
  
  RESULTS
  A Doppler ultrasound revealed thrombosis in the distal superficial femoral vein of the left leg. Hypercoagulable state markers were normal.
  
  
  CONCLUSIONS
  This case demonstrates that a pulmonary embolism could express itself as an ST depression myocardial ischemic event perhaps by affecting the coronary flow to the left anterior descending CA.
authors.affiliation: Landstuhl Regional Army Medical Center, Landstuhl, Germany.
authors.forename: Pasquale F
authors.initials: PF
authors.lastname: Nestico
authors.forename: Dimitri C
authors.initials: DC
authors.lastname: Cassimatis
authors.forename: Fareed
authors.initials: F
authors.lastname: Sheikh
authors.forename: Michael
authors.initials: M
authors.lastname: Huber
authors.forename: Jonathan
authors.initials: J
authors.lastname: Davison
authors.forename: Randolph
authors.initials: R
authors.lastname: Modlin
mesh_terms: D006328:Cardiac Catheterization; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D025401:Echocardiography, Stress; D005080:Exercise Test; D005268:Femoral Vein; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009206:Myocardium / Q000473:pathology*; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D013318:Stroke Volume; D013575:Syncope / Q000209:etiology*; D013923:Thromboembolism / Q000150:complications* / Q000000981:diagnostic imaging; D014481:United States