Pulmonary embolism mimicking myocardial ischemia in an Emergency Department.
A Nawaz, I Ahmed, A Butt
✦ AI-curated · Sources linked
Case in brief
A man in his seventies presented to the emergency department with sudden central chest pain radiating to both arms and diaphoresis, raising concern for myocardial ischemia. Observations, ECGs and serial troponins were normal. Further history identified earlier unilateral calf pain and recent long-haul travel. An elevated D-dimer prompted CT pulmonary angiography, which showed multiple segmental and subsegmental pulmonary emboli without right heart strain. He received therapeutic anticoagulation, later changed to apixaban for six months.
What made this case unusual
The pulmonary embolism presented with ischemia-like chest pain despite normal ECGs and serial troponins, illustrating how its presentation can resemble acute coronary disease.
Diagnostic / clinical pearl
In emergency chest pain assessment, normal ECGs and troponins do not exclude pulmonary embolism; structured history taking may reveal clues such as prior calf pain and recent long-haul travel.