An unusual presentation of massive pulmonary embolism mimicking septal acute myocardial infarction treated with tenecteplase

Journal of Thrombosis and Thrombolysis
Sergio FasulloPietro Di Pasquale

Abstract

A 31-year-old man (175 cm, 82 kg) was referred to the emergency department 2 h after the sudden onset of acute dyspnea. Immediate ECG showed sinus tachycardia with ST elevations from V1 through V2 and a diagnosis of septal acute myocardial infarction was made. ECG on admission to the cardiology department showed the same results plus the S1-Q3-T3 pattern. Echocardiogram revealed a normally contracting left ventricle, a distended right ventricle with free wall hypokinesia and displacement of the interventricular septum towards the left ventricle. Thrombolytic therapy with tenecteplase 8000 IU and heparin 5000 IU was administered 5-10 min after hospitalisation and the patient was haemodynamically stable 30 min later. Echocardiogram performed 12 h after thrombolysis showed a normal left ventricle and a less distended right ventricle. Lung spiral computed tomography (CT) and lower abdominal CT on the fourth day showed large emboli in the inferior pulmonary arteries of the right and left lung. Rarely, massive pulmonary embolism may mimic anteroseptal acute myocardial infarction on ECG and this case demonstrates the utility of echocardiography for a differential diagnosis, as well as the efficacy of tenecteplase for thrombolytic ther...Continue Reading

Citations

Aug 30, 2008·Journal of Thrombosis and Thrombolysis·Natale Daniele BrunettiMatteo Di Biase
Oct 30, 2012·Cardiology Clinics·Peter Pollak, William Brady
Nov 12, 2013·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Zhan Zhong-QunWang Xian-Ming
Mar 3, 2015·The American Journal of Emergency Medicine·Hesham R OmarEnrico M Camporesi
Mar 20, 2015·Case Reports in Emergency Medicine·David MigneaultFrançois de Champlain
Oct 12, 2011·Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre·Necla ÖzerSerdar Aksöyek
Sep 17, 2015·European Heart Journal. Acute Cardiovascular Care·Hesham R Omar
Apr 17, 2013·Herz·A Bozorgi, Z Rahnamoun
Apr 21, 2021·QJM : Monthly Journal of the Association of Physicians·Oscar M P Jolobe

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