title: Asymptomatic pulmonary embolus masquerading as acute anteroseptal myocardial infarction.
abstract: Pulmonary embolism (PE) is an uncommon and often overlooked cause of ST-segment elevation on the electrocardiogram (ECG). Emergent echocardiography has been cited as a means to rapidly distinguish acute myocardial infarction from PE. However, both of these conditions can present with focal wall motion abnormalities. We report a case of a 51-year-old asymptomatic male who presented to our emergency department with anterior ST-segment elevation and right-heart strain on an ECG. The clinical diagnosis of ST elevation myocardial infarction was in doubt, and an echocardiogram was obtained while the patient was in the emergency department. Although a focal area of hypokinesia was observed on echocardiography, cardiac catherization did not demonstrate any evidence of acute coronary occlusion. A computed tomographic angiogram of the chest was subsequently obtained, which demonstrated evidence of submassive pulmonary emboli. Our case highlights the limited utility of emergent echocardiography in cases of ST-segment elevation.
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco, CA 94143-0208, USA. Jeanne_noble@yahoo.com
authors.forename: Jeanne
authors.initials: J
authors.lastname: Noble
authors.forename: Amandeep
authors.initials: A
authors.lastname: Singh
mesh_terms: D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis*; D058070:Asymptomatic Diseases; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed