ST-Segment Elevation: An Unexpected Culprit
The clinical presentation of pulmonary embolism (PE) and acute coronary syndrome can be similar. We report a case of a patient presenting with antero-septal ST-segment elevation after cardiac arrest, found to have acute-PE-mimicking ST-segment elevation myocardial infarction (STEMI), treated with as...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-09-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/9/374 |
| _version_ | 1797579483147927552 |
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| author | David Sá Couto André Alexandre Ricardo Costa Andreia Campinas Mariana Santos Diana Ribeiro Severo Torres André Luz |
| author_facet | David Sá Couto André Alexandre Ricardo Costa Andreia Campinas Mariana Santos Diana Ribeiro Severo Torres André Luz |
| author_sort | David Sá Couto |
| collection | DOAJ |
| description | The clinical presentation of pulmonary embolism (PE) and acute coronary syndrome can be similar. We report a case of a patient presenting with antero-septal ST-segment elevation after cardiac arrest, found to have acute-PE-mimicking ST-segment elevation myocardial infarction (STEMI), treated with aspiration thrombectomy and catheter-directed thrombolysis (CDT). A 78-year-old man was admitted with dyspnea, chest pain and tachycardia. During evaluation, cardiac arrest in pulseless electrical activity was documented. Advanced life support was started immediately. ECG post-ROSC revealed ST-segment elevation in V1–V4 and aVR. Echocardiography showed normal left ventricular function but right ventricular (RV) dilation and severe dysfunction. The patient was in shock and was promptly referred to cardiac catheterization that excluded significant CAD. Due to the discordant ECG and echocardiogram findings, acute PE was suspected, and immediate invasive pulmonary angiography revealed bilateral massive pulmonary embolism. Successful aspiration thrombectomy was performed followed by local alteplase infusion. At the end of the procedure, mPAP was reduced and blood pressure normalized allowing withdrawal of vasopressor support. Twenty-four-hour echocardiographic reassessment showed normal-sized cardiac chambers with preserved biventricular systolic function. Bedside echocardiography in patients with ST-segment elevation post-ROSC is instrumental in raising the suspicion of acute PE. In the absence of a culprit coronary lesion, prompt pulmonary angiography should be considered if immediately feasible. In these cases, CDT and aspiration in high-risk acute PE seem safe and effective in relieving obstructive shock and restoring hemodynamics. |
| first_indexed | 2024-03-10T22:37:48Z |
| format | Article |
| id | doaj.art-057aaf226a4c4046b5115916ea84a37d |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-10T22:37:48Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-057aaf226a4c4046b5115916ea84a37d2023-11-19T11:16:32ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-09-0110937410.3390/jcdd10090374ST-Segment Elevation: An Unexpected CulpritDavid Sá Couto0André Alexandre1Ricardo Costa2Andreia Campinas3Mariana Santos4Diana Ribeiro5Severo Torres6André Luz7Cardiology Department, Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001 Porto, PortugalCardiology Department, Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001 Porto, PortugalCardiology Department, Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001 Porto, PortugalCardiology Department, Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001 Porto, PortugalCardiology Department, Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001 Porto, PortugalCardiology Department, Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001 Porto, PortugalCardiology Department, Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001 Porto, PortugalCardiology Department, Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001 Porto, PortugalThe clinical presentation of pulmonary embolism (PE) and acute coronary syndrome can be similar. We report a case of a patient presenting with antero-septal ST-segment elevation after cardiac arrest, found to have acute-PE-mimicking ST-segment elevation myocardial infarction (STEMI), treated with aspiration thrombectomy and catheter-directed thrombolysis (CDT). A 78-year-old man was admitted with dyspnea, chest pain and tachycardia. During evaluation, cardiac arrest in pulseless electrical activity was documented. Advanced life support was started immediately. ECG post-ROSC revealed ST-segment elevation in V1–V4 and aVR. Echocardiography showed normal left ventricular function but right ventricular (RV) dilation and severe dysfunction. The patient was in shock and was promptly referred to cardiac catheterization that excluded significant CAD. Due to the discordant ECG and echocardiogram findings, acute PE was suspected, and immediate invasive pulmonary angiography revealed bilateral massive pulmonary embolism. Successful aspiration thrombectomy was performed followed by local alteplase infusion. At the end of the procedure, mPAP was reduced and blood pressure normalized allowing withdrawal of vasopressor support. Twenty-four-hour echocardiographic reassessment showed normal-sized cardiac chambers with preserved biventricular systolic function. Bedside echocardiography in patients with ST-segment elevation post-ROSC is instrumental in raising the suspicion of acute PE. In the absence of a culprit coronary lesion, prompt pulmonary angiography should be considered if immediately feasible. In these cases, CDT and aspiration in high-risk acute PE seem safe and effective in relieving obstructive shock and restoring hemodynamics.https://www.mdpi.com/2308-3425/10/9/374ST-segmentacute pulmonary embolismcatheter-directed therapyintervention cardiologythrombolysisaspiration thrombectomy |
| spellingShingle | David Sá Couto André Alexandre Ricardo Costa Andreia Campinas Mariana Santos Diana Ribeiro Severo Torres André Luz ST-Segment Elevation: An Unexpected Culprit Journal of Cardiovascular Development and Disease ST-segment acute pulmonary embolism catheter-directed therapy intervention cardiology thrombolysis aspiration thrombectomy |
| title | ST-Segment Elevation: An Unexpected Culprit |
| title_full | ST-Segment Elevation: An Unexpected Culprit |
| title_fullStr | ST-Segment Elevation: An Unexpected Culprit |
| title_full_unstemmed | ST-Segment Elevation: An Unexpected Culprit |
| title_short | ST-Segment Elevation: An Unexpected Culprit |
| title_sort | st segment elevation an unexpected culprit |
| topic | ST-segment acute pulmonary embolism catheter-directed therapy intervention cardiology thrombolysis aspiration thrombectomy |
| url | https://www.mdpi.com/2308-3425/10/9/374 |
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