Massive pulmonary embolism with ST-segment elevation mimicking an isolated right ventricular myocardial infarction in a patient with COVID-19 pneumonia: Case report

• Published in: Annals of medicine and surgery Vol. 84; p. 104943
• Main Authors: El-Azrak, Mohammed, Boutaybi, Mohammed, Mouedder, Fadoua, EL Ouafi, Noha, Ismaili, Nabila
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2022
• Subjects: COVID 19 pneumonia; Pulmonary embolism; Right ventricular infarction; ST-Segment elevation; Pulmonary embolism; Right ventricular infarction; ST-Segment elevation; COVID 19 pneumonia
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1016/j.amsu.2022.104943

Pulmonary embolism (PE) is a great simulator; It mimics step by step its main differential diagnosis which is myocardial infarction. Its clinical and electrical manifestations are unspecific. Rarely, an ST-segment elevation can occur making the diagnosis more difficult. Recognizing such an uncommon electrocardiographic (ECG) pattern is of an important relevance to lead to a prompt and suitable therapeutic management. In our paper, we discuss a 68 years-old man case who presents with dyspnea and chest pain with ST-segment elevation in V1, aVR, DIII, and right-sided leads suggestive of isolated right ventricular infarction, admitted in a stable hemodynamical status which rapidly deteriorated. Echocardiographic assessment has shown signs of acute pulmonary heart disease with the presence of the specific McConnell's sign. A computed tomography pulmonary angiogram was performed revealing massive bilateral PE that benefited from thrombolytic therapy with alteplase with a remarkable following and regression of the ST-segment elevation. To our knowledge, this is the first case report of massive PE presenting with these ECG findings in the context of COVID 19 pneumonia, of which practitioners should be aware to better orient diagnosis and therapeutic management.
•Pulmonary embolism can rarely present with an ST-segment elevation.•We discuss a case of patient who presents with electrographic aspect suggestive of isolated right ventricular infarction that was shown to be a massive pulmonary embolism (PE).•This is the first case report of massive PE presenting with these ECG findings in the context of COVID 19 pneumonia.