The dilemma of the “ischemic-looking” electrocardiogram: Pulmonary embolism or acute coronary syndrome?

• Main Authors: Paurush Ambesh, Aditya Kapoor, Sudeep Kumar, Sunil K Jain
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Annals of Cardiac Anaesthesia
• Subjects: Acute coronary syndrome; acute pulmonary embolism; electrocardiogram
• Online Access: http://www.annals.in/article.asp?issn=0971-9784;year=2019;volume=22;issue=1;spage=89;epage=91;aulast=Ambesh

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.