Acute pulmonary embolism with electrocardiagraphic changes mimicking acute coronary syndrome: a case report and literature review

摘要

Acute pulmonary embolism (PE) is potentially a life threatening emergency that needs prompt management to reduce preventable deaths. Symptoms like dyspnoea and chest discomfort often lack specificity and overlap with acute coronary syndrome (ACS). Importantly, electrocardiographic changes associated with PE are reported to be variable with some ECG patterns mimicking ACS, posing problems in the differential diagnosis. More recently, precordial T wave inversion has been described to be a clue to suggest PE. However, this ECG change is more likely to present in ACS. We herein reported a case of a 78-year-old man presenting with progressive shortness of breath on exertion secondary to submassive pulmonary embolism which was initially misdiagnosed as ACS due to diffuse T wave inversion in both precordial leads V1-6 and inferior Leads II, III and aVF. Here, we discussed the diagnosis of this case and reviewed the medical literature with an emphasis on the limitations of ECG for the differentiation between PE and ACS.