Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction

Pedro A. Villablanca, Peter P. Vlismas, Tatsiana Aleksandrovich, Arthur Omondi, Tanush Gupta, David F. Briceno, Mario J. Garcia, Jose M. Wiley

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: To study trends in the clinical presentation, electrocardiograms, and diagnostic imaging in patients with pulmonary embolism presenting as ST segment elevation. Methods: We performed a systematic literature search for all reported cases of pulmonary embolism mimicking ST-elevation myocardial infarction. Pre-specified data such as clinical presentation, electrocardiogram changes, transthoracic echocardiographic findings, cardiac biomarkers, diagnostic imaging, therapy, and outcomes were collected. Results: We identified a total of 34 case reports. There were 23 males. Mean age of the population was 56.5 ± 15.5 years. Patients presented with dyspnea (76.4%), chest pain (63.6%), and tachycardia (71.4%). All patients presented with ST-elevations, with the most common location being in the anterior-septal distribution, lead V3 (74%), V2 (71%), V1 (62%) and V4 (47%). ST-segment elevations in the inferior distribution were present in lead II (12%), III (18%), and aVF (21%). Presentation was least likely in the lateral distribution. Troponin was elevated in 78.9% of cases. Right ventricular strain was the most common echocardiographic finding. Over 80% of patients had findings consistent with elevated right ventricular pressure, with 50% reported RV dilatation and 20% RV hypokinesis. The most commonly used imaging modality was contrast-enhanced pulmonary angiography. There was a greater incidence of bilateral compared to unilateral pulmonary emboli (72.4% vs. 10%). About 65% patients received anticoagulation and 36.3% were treated with thrombolytics. Forty-six percent of patients required intensive care and 18.7% intubation. Overall mortality was 25.8%. Conclusions: A review of the literature reveals that in patients presenting with pulmonary embolism, electrocardiogram findings of ST-segment elevations will occur predominantly in the anterior-septal distribution.

Original languageEnglish (US)
JournalVascular
DOIs
StateAccepted/In press - Jan 1 2018

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Pulmonary Embolism
Electrocardiography
Diagnostic Imaging
Lung
Troponin
Ventricular Pressure
Critical Care
ST Elevation Myocardial Infarction
Embolism
Chest Pain
Intubation
Tachycardia
Dyspnea
Dilatation
Angiography
Biomarkers
Mortality
Incidence
Population

Keywords

  • meta-analysis
  • Pulmonary embolism
  • ST-elevations

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Villablanca, P. A., Vlismas, P. P., Aleksandrovich, T., Omondi, A., Gupta, T., Briceno, D. F., ... Wiley, J. M. (Accepted/In press). Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction. Vascular. https://doi.org/10.1177/1708538118791917

Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction. / Villablanca, Pedro A.; Vlismas, Peter P.; Aleksandrovich, Tatsiana; Omondi, Arthur; Gupta, Tanush; Briceno, David F.; Garcia, Mario J.; Wiley, Jose M.

In: Vascular, 01.01.2018.

Research output: Contribution to journalArticle

Villablanca PA, Vlismas PP, Aleksandrovich T, Omondi A, Gupta T, Briceno DF et al. Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction. Vascular. 2018 Jan 1. https://doi.org/10.1177/1708538118791917
Villablanca, Pedro A. ; Vlismas, Peter P. ; Aleksandrovich, Tatsiana ; Omondi, Arthur ; Gupta, Tanush ; Briceno, David F. ; Garcia, Mario J. ; Wiley, Jose M. / Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction. In: Vascular. 2018.
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abstract = "Background: To study trends in the clinical presentation, electrocardiograms, and diagnostic imaging in patients with pulmonary embolism presenting as ST segment elevation. Methods: We performed a systematic literature search for all reported cases of pulmonary embolism mimicking ST-elevation myocardial infarction. Pre-specified data such as clinical presentation, electrocardiogram changes, transthoracic echocardiographic findings, cardiac biomarkers, diagnostic imaging, therapy, and outcomes were collected. Results: We identified a total of 34 case reports. There were 23 males. Mean age of the population was 56.5 ± 15.5 years. Patients presented with dyspnea (76.4{\%}), chest pain (63.6{\%}), and tachycardia (71.4{\%}). All patients presented with ST-elevations, with the most common location being in the anterior-septal distribution, lead V3 (74{\%}), V2 (71{\%}), V1 (62{\%}) and V4 (47{\%}). ST-segment elevations in the inferior distribution were present in lead II (12{\%}), III (18{\%}), and aVF (21{\%}). Presentation was least likely in the lateral distribution. Troponin was elevated in 78.9{\%} of cases. Right ventricular strain was the most common echocardiographic finding. Over 80{\%} of patients had findings consistent with elevated right ventricular pressure, with 50{\%} reported RV dilatation and 20{\%} RV hypokinesis. The most commonly used imaging modality was contrast-enhanced pulmonary angiography. There was a greater incidence of bilateral compared to unilateral pulmonary emboli (72.4{\%} vs. 10{\%}). About 65{\%} patients received anticoagulation and 36.3{\%} were treated with thrombolytics. Forty-six percent of patients required intensive care and 18.7{\%} intubation. Overall mortality was 25.8{\%}. Conclusions: A review of the literature reveals that in patients presenting with pulmonary embolism, electrocardiogram findings of ST-segment elevations will occur predominantly in the anterior-septal distribution.",
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AU - Omondi, Arthur

AU - Gupta, Tanush

AU - Briceno, David F.

AU - Garcia, Mario J.

AU - Wiley, Jose M.

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N2 - Background: To study trends in the clinical presentation, electrocardiograms, and diagnostic imaging in patients with pulmonary embolism presenting as ST segment elevation. Methods: We performed a systematic literature search for all reported cases of pulmonary embolism mimicking ST-elevation myocardial infarction. Pre-specified data such as clinical presentation, electrocardiogram changes, transthoracic echocardiographic findings, cardiac biomarkers, diagnostic imaging, therapy, and outcomes were collected. Results: We identified a total of 34 case reports. There were 23 males. Mean age of the population was 56.5 ± 15.5 years. Patients presented with dyspnea (76.4%), chest pain (63.6%), and tachycardia (71.4%). All patients presented with ST-elevations, with the most common location being in the anterior-septal distribution, lead V3 (74%), V2 (71%), V1 (62%) and V4 (47%). ST-segment elevations in the inferior distribution were present in lead II (12%), III (18%), and aVF (21%). Presentation was least likely in the lateral distribution. Troponin was elevated in 78.9% of cases. Right ventricular strain was the most common echocardiographic finding. Over 80% of patients had findings consistent with elevated right ventricular pressure, with 50% reported RV dilatation and 20% RV hypokinesis. The most commonly used imaging modality was contrast-enhanced pulmonary angiography. There was a greater incidence of bilateral compared to unilateral pulmonary emboli (72.4% vs. 10%). About 65% patients received anticoagulation and 36.3% were treated with thrombolytics. Forty-six percent of patients required intensive care and 18.7% intubation. Overall mortality was 25.8%. Conclusions: A review of the literature reveals that in patients presenting with pulmonary embolism, electrocardiogram findings of ST-segment elevations will occur predominantly in the anterior-septal distribution.

AB - Background: To study trends in the clinical presentation, electrocardiograms, and diagnostic imaging in patients with pulmonary embolism presenting as ST segment elevation. Methods: We performed a systematic literature search for all reported cases of pulmonary embolism mimicking ST-elevation myocardial infarction. Pre-specified data such as clinical presentation, electrocardiogram changes, transthoracic echocardiographic findings, cardiac biomarkers, diagnostic imaging, therapy, and outcomes were collected. Results: We identified a total of 34 case reports. There were 23 males. Mean age of the population was 56.5 ± 15.5 years. Patients presented with dyspnea (76.4%), chest pain (63.6%), and tachycardia (71.4%). All patients presented with ST-elevations, with the most common location being in the anterior-septal distribution, lead V3 (74%), V2 (71%), V1 (62%) and V4 (47%). ST-segment elevations in the inferior distribution were present in lead II (12%), III (18%), and aVF (21%). Presentation was least likely in the lateral distribution. Troponin was elevated in 78.9% of cases. Right ventricular strain was the most common echocardiographic finding. Over 80% of patients had findings consistent with elevated right ventricular pressure, with 50% reported RV dilatation and 20% RV hypokinesis. The most commonly used imaging modality was contrast-enhanced pulmonary angiography. There was a greater incidence of bilateral compared to unilateral pulmonary emboli (72.4% vs. 10%). About 65% patients received anticoagulation and 36.3% were treated with thrombolytics. Forty-six percent of patients required intensive care and 18.7% intubation. Overall mortality was 25.8%. Conclusions: A review of the literature reveals that in patients presenting with pulmonary embolism, electrocardiogram findings of ST-segment elevations will occur predominantly in the anterior-septal distribution.

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