ABSTRACT

Clinical and electocardiographic (ECG) features in pulmonaryembolism(PE) lack of specificity andmay mimic an acute coronary syndrom (ACS). We here report a case of a 56-year-old woman presenting with chest pain secondary to pulmonary artery embolismwhichwas initially diagnosed as ACS due to electrocardiographic changes and raised troponin. PE presenting with negative T-wave inversion can mimic ACS and misdirect the diagnostic approach. Simultaneous T-wave inversions in anterior and inferior leads are important clues suggesting PE.Most common ECG findings in PE are anteroseptal T-wave inversion/ST-elevation or depression along with complete or incomplete right bundle branch block, sinus tachycardia, low QRS-complex voltage, an S1Q3T3 pattern, and right axis deviation. The reasons for the ECG changes that seem like ischemia are sudden RV strain, hypoxemia and the release of catecholamines. So we have to be aware that PE can present as acute coronary syndrome with ECG changes preoccupy ischemia