title: Massive Pulmonary Embolism Mimicking Acute Myocardial Infarction: Successful use of extracorporeal membrane oxygenation support as bridge to diagnosis.
abstract: Prolonged cardiac arrest with pulseless electrical activity (PEA) results in death if its aetiology cannot be corrected immediately. We describe the case of a 75-year-old man with chest pain and his electrocardiogram (ECG) revealing ST-segment elevation in leads II, III, and aVf. Inferior wall myocardial infarction was subsequently diagnosed. Before performing emergency coronary angiography, however, a sudden cardiac arrest with PEA developed and the patient was placed on advanced cardiac life support. Oxygenation support for the extracorporeal membrane was initiated approximately 65min after prolonged cardiopulmonary resuscitation. Emergency coronary arteriogram showed no obstructive lesions in the right coronary artery. This result, however, was not consistent with the ECG findings, and thus, a massive pulmonary embolism was suspected. Subsequent pulmonary artery angiography showed severe emboli in bilateral branches of the pulmonary arteries. Catheter-directed thrombolysis with urokinase was administered, which ultimately failed, and surgical embolectomy was performed with extracorporeal membrane oxygenation support. After the above intervention, the patient was discharged on hospital day 60 without any sequelae or neurological deficits.
authors.affiliation: Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yung-Kun
authors.initials: YK
authors.lastname: Hsieh
authors.affiliation: Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Fu-Yuan
authors.initials: FY
authors.lastname: Siao
authors.affiliation: Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Chiu
authors.affiliation: Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Chan-Shan Medical University, Taichung, Taiwan. Electronic address: 91646@cch.org.tw.
authors.forename: Hsu-Heng
authors.initials: HH
authors.lastname: Yen
authors.affiliation: Department of Cardiovascular Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yao-Li
authors.initials: YL
authors.lastname: Chen
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy
keywords: Cardiac arrest; Extracorporeal membrane oxygenation support; Pulmonary embolism