PDF(Pubmed)
Abstract：
Acute pulmonary embolism (APE) with ST-segment elevation and an upward T-wave is rare, and only a few cases have been reported to date. We herein present a case involving a man in his early 70s with an 8-hour history of dyspnea. Serial electrocardiography (ECG) demonstrated ST-segment elevation in leads V1 to V3 with an upward T-wave, laboratory tests revealed a high serum concentration of high-sensitivity cardiac troponin I, and signs of acute myocardial infarction were present. However, emergency coronary angiography revealed normal coronary arteries. A subsequent computed tomography scan of the pulmonary arteries showed findings consistent with APE. The patient\'s chest tightness was relieved after catheter-directed thrombolysis. Postoperative ECG showed that the ST-segment in leads V1 to V3 had fallen back and that the T-wave was inverted. The patient was discharged on rivaroxaban therapy. Clinically, the ECG findings of ST-segment elevation and an upward T-wave in APE can be easily misdiagnosed as acute myocardial infarction. Physicians should maintain clinical suspicion through risk stratification to identify APE.
摘要：
急性肺栓塞（APE）伴有ST段抬高和T波上升是罕见的，到目前为止只报告了几例。我们在此介绍一例涉及一名70岁出头有8小时呼吸困难病史的男子的病例。连续心电图（ECG）显示V1至V3导联ST段抬高，T波向上，实验室检查显示血清中高敏肌钙蛋白I的浓度，并有急性心肌梗死的征象。然而,急诊冠状动脉造影显示冠状动脉正常.随后的肺动脉计算机断层扫描显示发现与APE一致。患者经导管溶栓后胸闷缓解。术后心电图显示V1至V3导联的ST段回落，T波倒置。患者接受利伐沙班治疗后出院。临床上,APE的ST段抬高和T波向上的心电图结果容易误诊为急性心肌梗死。医师应通过风险分层来保持临床怀疑，以识别APE。
