Volume 13 - Supplement, Winter
aumj 2024, 13 - Supplement, Winter: 43-48 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Alizadeh Kashani R, Hatamian S, Hamidian S, Nourian N. Diagnosis of acute pulmonary embolism with EKG changes Similar to acute coronary syndrome by bedside cardiac Ultrasound evaluation: case report and review of article. aumj 2024; 13 :43-48
URL: http://aums.abzums.ac.ir/article-1-1793-en.html
URL: http://aums.abzums.ac.ir/article-1-1793-en.html
1- Assistant Professor of Anesthesiology and Special Care, Clinical Research Development Unit, Shahid Madani Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
2- Student of Anesthesiology and Special Care Residency, Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
3- Bachelor of Nursing , Special Care Department, clinical research development unit , Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
2- Student of Anesthesiology and Special Care Residency, Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
3- Bachelor of Nursing , Special Care Department, clinical research development unit , Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
Abstract: (1045 Views)
Introduction: Acute pulmonary embolism (PE) is an emergency and life-threatening disease that despite its relatively high prevalence in ICU patients, is still difficult to diagnose due to non-specific signs and symptoms. Symptoms such as shortness of breath and chest discomfort are completely non-specific and overlap with the diagnosis of acute coronary syndrome (ACS).
Materials and methods: EKG changes associated with acute pulmonary embolism are highly variable and can resemble acute coronary syndromes. Recently, changes in precordial leads in the form of inverted T wave have been described as a diagnostic clue of PE, although these changes are also seen in acute coronary syndrome.
Results: In this article, we report a 92-year-old man with dyspnea and progressive hypotension. Which was initially wrongly diagnosed as acute coronary syndrome due to diffuse inverted T in precordial leads V1 to V6, and pulmonary embolism was confirmed after cardiac ultrasound evaluation at the bedside.
Conclusion: In this article, we will talk about the diagnosis of this case and the review of related texts, emphasizing the limitations of EKG and the importance of using cardiopulmonary ultrasound at the bedside.
Materials and methods: EKG changes associated with acute pulmonary embolism are highly variable and can resemble acute coronary syndromes. Recently, changes in precordial leads in the form of inverted T wave have been described as a diagnostic clue of PE, although these changes are also seen in acute coronary syndrome.
Results: In this article, we report a 92-year-old man with dyspnea and progressive hypotension. Which was initially wrongly diagnosed as acute coronary syndrome due to diffuse inverted T in precordial leads V1 to V6, and pulmonary embolism was confirmed after cardiac ultrasound evaluation at the bedside.
Conclusion: In this article, we will talk about the diagnosis of this case and the review of related texts, emphasizing the limitations of EKG and the importance of using cardiopulmonary ultrasound at the bedside.
Keywords: Acute pulmonary embolism, acute coronary syndrome, T wave inversion, bedside cardiopulmonary ultrasound
Type of Study: Original |
Subject:
Special
Received: 2023/12/16 | Accepted: 2024/02/04 | Published: 2024/02/28
Received: 2023/12/16 | Accepted: 2024/02/04 | Published: 2024/02/28
References
1. Shepherd, T.D., T.S. Niaz, and R. Yadav. Massive pulmonary embolism treated with low-dose thrombolysis on the geriatric ward during the COVID-19 pandemic. BMJ Case Reports CP 2022; 15(4): e248125. [DOI:10.1136/bcr-2021-248125]
2. Fedullo, P.F. and V.F. Tapson. The evaluation of suspected pulmonary embolism. New England Journal of Medicine 2003; 349(13): 1247-1256. [DOI:10.1056/NEJMcp035442]
3. Rodger, M., et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. American Journal of Cardiology 2000; 86(7): 807-809. [DOI:10.1016/S0002-9149(00)01090-0]
4. Sinha, N., et al. Role of the 12-lead electrocardiogram in diagnosing pulmonary embolism. Cardiology in review 2005; 13(1): 46-49. [DOI:10.1097/01.crd.0000134647.55135.4a]
5. Chung-Esaki, H., et al. Detection of acute pulmonary embolism by bedside ultrasound in a patient presenting in PEA arrest: a case report. Case Reports in Emergency Medicine 2012. [DOI:10.1155/2012/794019]
6. Konstantinides, S. Acute pulmonary embolism. New England Journal of Medicine 2008; 359(26): 2804-2813. [DOI:10.1056/NEJMcp0804570]
7. Cavallazzi, R., et al. Natriuretic peptides in acute pulmonary embolism: a systematic review. Intensive care medicine 2008; 34: 2147-2156. [DOI:10.1007/s00134-008-1214-5]
8. Torbicki, A. (Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008; 29: 2276-2315.
9. McGinn, S. and P.D. White. Acute cor pulmonale resulting from pulmonary embolism: its clinical recognition. Journal of the American Medical Association 1935; 104(17): 1473-1480. [DOI:10.1001/jama.1935.02760170011004]
10. Sukhija, R., et al. Electrocardiographic abnormalities in patients with right ventricular dilation due to acute pulmonary embolism. Cardiology 2005;105(1): 57-60. [DOI:10.1159/000089249]
11. Yeh, K.-H. and H.-C. Chang. Massive pulmonary embolism with anterolateral ST-segment elevation: electrocardiogram limitations and the role of echocardiogram. The American journal of emergency medicine 2008; 26(5): 632. e1-632. e3. [DOI:10.1016/j.ajem.2007.09.021]
12. Wilson, G.T. and F.A. Schaller. Pulmonary embolism mimicking anteroseptal acute myocardial infarction. Journal of Osteopathic Medicine 2008; 108(7): 344-349.
13. Kosuge, M., et al. Electrocardiographic differentiation between acute pulmonary embolism and acute coronary syndromes on the basis of negative T waves. The American journal of cardiology 2007; 99(6): 817-821. [DOI:10.1016/j.amjcard.2006.10.043]
14. Witting, M.D., et al. Simultaneous T-wave inversions in anterior and inferior leads: an uncommon sign of pulmonary embolism. The Journal of Emergency Medicine 2012; 43(2): 228-235. [DOI:10.1016/j.jemermed.2011.07.026]
15. Kosuge, M., et al. Differences in negative T waves between acute pulmonary embolism and acute coronary syndrome. Circulation Journal 2014; 78(2): 483-489. [DOI:10.1253/circj.CJ-13-1064]
16. Stein, P.D., et al. The electrocardiogram in acute pulmonary embolism. Progress in cardiovascular diseases 1975; 17(4): 247-257. [DOI:10.1016/S0033-0620(75)80016-8]
17. Stein, P.D., et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991; 100(3): 598-603. [DOI:10.1378/chest.100.3.598]
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
