Available online 11 March 2024

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Electrocardiographic (ECG) abnormalities are seen in 70%–80% of patients with acute pulmonary embolism (PE). Rarely, acute PE presents with ST-segment elevation (STE) in leads II; III and aVF and V1–3 mimicking ST-segment elevation myocardial infarction (STEMI). Herein, we describe a case of acute PE presenting with STE in II; III and aVF and V1–3.

Section snippetsCase presentation

A 60-year-old woman experienced sudden loss of consciousness and became pulseless 1 day after undergoing radiofrequency ablation for premature ventricular contraction (Fig. 1). Pulse was reestablished by cardiopulmonary resuscitation, but blood pressure (BP) was still undetectable. Jugular venous distention and right lower extremity edema were prominent. Troponin I and D-dimer were 2.46 ng/mL (reference range: < 0.06 ng/mL) and 3.36μg/mL (reference range: < 0.5μg/mL), respectively. But

Interpretation

ECG also showed the absence of P wave, bradycardia, right bundle branch block (RBBB) with right axis deviation, ST-segment elevation (STE) in inferior leads II, III, aVF, and precordial leads V1–3, V3R-V5R and probably retrogradely conducted P waves with RP interval around 0.11 to 0.12 s. exist, best seen in aVF, II, V3–5. The STE in inferior leads and precordial leads might indict right ventricular (RV) transmural ischemia. However, echocardiography revealed RV dilatation and ultrasound

Clinical course

The absence of P wave and sinus bradycardia suggested junction escape rhythm. The STE in leads II, III, aVF, and V1–3 highly suggested inferior myocardial infarction. The sudden loss of consciousness and hypotension also hinted acute coronary syndrome. However, prominent jugular venous distention and right lower extremity edema due to vein thrombosis were not consistent with that diagnosis. RBBB in ECG, enlarged right atrium and the ventricular septum shifting toward the left ventricle in

Discussion

We speculate that STE confined to the inferior leads may result from transmural right ventricular (RV) ischemia. Fig. 2 clearly showed STE in the right precordial V1 and V3R-V5R leads, which is a typical ischemic pattern in acute PE. In inferior STE myocardial infarction, ST depression can be found in the right precordial leads and may be an electrical mirror phenomenon Hence, we speculate that STE in the inferior leads can counteract STE in the right precordial leads. STE confined to the

CRediT authorship contribution statement

Yan-Guang Mou: Writing – original draft, Formal analysis, Data curation. Tian Zhang: Writing – review & editing, Writing – original draft. Yun-Tao Zhao: Conceptualization.

Declaration of competing interest

None.

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