The Crucial Role of Bedside Echocardiography and Clinical Suspicion in Diagnosing Pulmonary Embolism With ST Elevation on ECG, Initially Misdiagnosed as ST-Segment Elevation Myocardial Infarction (STEMI)

Abstract

Pulmonary embolism (PE) is a life-threatening condition with varied presentations, occasionally mimicking ST-segment elevation myocardial infarction (STEMI). This case highlights a 52-year-old male patient with a history of venous thromboembolism (VTE) who presented with progressive shortness of breath over a month, culminating in dyspnea at rest, and anterior ST-segment elevation on electrocardiography (ECG). The initial evaluation suggested STEMI. Notably, chest pain, a typical feature of STEMI, was absent. This combined with the patient's clinical background and shortness of breath as presenting symptoms prompted further investigation. Bedside echocardiography revealed right ventricular dilation and dysfunction, and computed tomography (CT) pulmonary angiography confirmed massive PE. Despite anticoagulation and mechanical thrombectomy, the patient succumbed to complications before pulmonary endarterectomy. This report underscores the importance of integrating clinical acumen, advanced imaging modalities, and timely multidisciplinary collaboration to avoid misdiagnosis and optimize patient outcomes in critical cases.