scholarly journals Case Report: Diffuse T wave inversions as initial electrocardiographic evidence in acute pulmonary embolism

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 738 ◽  
Author(s):  
Ogechukwu Egini ◽  
Alix Dufresne ◽  
Mazin Khalid ◽  
Chinedu Egini ◽  
Eric Jaffe
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Signs ◽  
Troponin Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Threatening Condition ◽  
Life Threatening ◽  
Work Up ◽  
Typical Chest Pain

Acute pulmonary embolism (PE) is a life-threatening condition and is typically diagnosed by a combination of symptoms, clinical signs and imaging. Electrocardiogram may be helpful in diagnosis, and the most widely described pattern of occurrence is the so-called S1Q3T3 pattern. Here, we describe the case of an African-American male who presented with typical chest pain, diffuse T wave inversions with serial troponin elevation. There was initial concern for Wellen's syndrome but was finally diagnosed as acute PE. This case underscores the necessity of vigilance and a lower threshold for PE work up even in patients presenting as acute coronary syndrome.

scholarly journals Case Report: Diffuse T wave inversions as initial electrocardiographic evidence in acute pulmonary embolism

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 738
Author(s):  
Ogechukwu Egini ◽  
Alix Dufresne ◽  
Mazin Khalid ◽  
Chinedu Egini ◽  
Eric Jaffe
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Signs ◽  
Troponin Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Threatening Condition ◽  
Life Threatening ◽  
Work Up ◽  
Typical Chest Pain

Acute pulmonary embolism (PE) is a life-threatening condition and is typically diagnosed by a combination of symptoms, clinical signs and imaging. Electrocardiogram may be helpful in diagnosis, and the most widely described pattern of occurrence is the so-called S1Q3T3 pattern. Here, we describe the case of an African-American male who presented with typical chest pain, diffuse T wave inversions with serial troponin elevation. There was initial concern for Wellen's syndrome but was finally diagnosed as acute PE. This case underscores the necessity of vigilance and a lower threshold for PE work up even in patients presenting as acute coronary syndrome.

scholarly journals T-wave inversion in the precordial leads: сardiac and non-cardiac causes

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 136-145
Author(s):  
I. R. Tsoy ◽  
I. P. Kolos
Keyword(s):  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Arrhythmogenic Cardiomyopathy ◽  
Cardiac Memory ◽  
T Wave ◽  
Wave Inversion ◽  
Threatening Condition ◽  
Life Threatening

The T-wave inversion (TWI) is a common electrocardiographic finding. Causes for TWI are numerous and sometimes TWI may appear in life-threatening conditions. The aim of this review was to provide an up-to-date analysis of TWI, including i) definition and prevalence; ii) causes, and iii) differential diagnosis in benign TWI, reversible myocardial ischemia of the left ventricular anterior wall; takotsubo cardiomyopathy; subarachnoid hemorrhage; pulmonary embolism; right ventricular arrhythmogenic cardiomyopathy; and “cardiac memory”. The review presents practical electrophysiological criteria, which allow suspecting in time a life-threatening condition to choose an up-to-date treatment.

scholarly journals Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium

2019 ◽  
Vol 25 ◽  
pp. 107602961985303 ◽  
Author(s):  
Belinda Rivera-Lebron ◽  
Michael McDaniel ◽  
Kamran Ahrar ◽  
Abdulah Alrifai ◽  
David M. Dudzinski ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
International Association ◽  
Response Team ◽  
Threatening Condition ◽  
Life Threatening ◽  
Acute Pe ◽  
Careful Assessment ◽  
Pulmonary Embolism Response Team

Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.

McConnell’s Sign As An indicator of Right Ventricular Infarction: A Case Report

2021 ◽  
Author(s):  
Judah Nijas Arul ◽  
Preetam Krishnamurthy ◽  
Balakrishnan Vinod Kumar ◽  
Thoddi Ramamurthy Muralidharan ◽  
Senguttuvan Nagendra Boopathy ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Medical Management ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Ventricular Infarction ◽  
Coronary Syndrome ◽  
Pulmonary Angiogram ◽  
Ventricular Infarction

Abstract BackgroundMcConnell’s sign is a specific echocardiographic finding that was first described in patient with acute pulmonary embolism signifying right ventricular dysfunction. It remains an under-recognized sign in patients with right ventricular infarction.Case PresentationAn 80-year-old woman presented with sudden onset chest pain and breathlessness. The electrocardiogram showed features suggestive of inferior, posterior, and right ventricular infarction with complete heart block and McConnell’s sign was seen on the echocardiography. CT pulmonary angiogram ruled out the present of pulmonary thromboembolism. Coronary angiogram revealed an occluded right coronary artery with collateral supply from the left circulation. Medical management was planned after patient-physician discussion. Patient symptomatically improved with medical management.ConclusionAlthough McConnell’s sign is suggestive of acute pulmonary embolism, it may also be present in patients with right ventricular dysfunction due to infarction. The presence of McConnell’s sign in a patient presenting with acute coronary syndrome should prompt evaluation for right ventricular infarction in the absence of acute pulmonary embolism.

scholarly journals A visualized pulmonary arterial thrombus by using a new  echocardiographic view in an intermediate-risk a cute pulmonary embolism  patient: a case report

2019 ◽  
Author(s):  
Guanyu Mu ◽  
Feixue Li ◽  
Xiaolin Chen ◽  
Bo Zhao ◽  
Guangping Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Pulmonary Angiography ◽  
Normal Blood ◽  
Intermediate Risk ◽  
Normal Blood Pressure

Abstract BackgroundAcute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A new recommended echocardiography view may be of further help in the diagnosis, evaluate the change of the thrombosis and treatment effect.Case presentationWe report a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnoea. The patient was diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed decrease in RV diameter and pulmonary artery thrombus. ConclusionThis case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The new echocardiographic view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

scholarly journals Treatment of Pulmonary Embolism: a Decade of Experience

2019 ◽  
pp. 46-49
Author(s):  
A. Nikonenko ◽  
A. Nikonenko ◽  
S. Matvieiev ◽  
V. Osaulenko ◽  
S. Nakonechniy
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Acute Pulmonary Embolism ◽  
High Efficiency ◽  
Oral Anticoagulants ◽  
Fibrinolytic Therapy ◽  
Major Life ◽  
Life Threatening Illness ◽  
The World ◽  
Life Threatening

Pulmonary embolism (PE) is a major life-threatening illness which remains one of the main causes of sudden death throughout the world. The analysis of diagnosis and treatment of 472 patients with acute pulmonary embolism for a period of 10 years was performed. High efficiency of diagnosis using multispiral computer angiopulmonography (MSCT APG) has been established, thus this method completely supersedes the traditional selective angiopulmonography. Seventeen (3.6 %) patients died due to PE recurrence, another 8 (1.7 %) patients died due to the bleeding after using fibrinolytics and anticoagulants, and 14 (2.9 %) died due to progression of organs failure. This emphasizes the need to improve measures aimed to prevent PE recurrence and identify sources of possible bleeding and refrain from aggressive fibrinolytic therapy. The use of differentiated approach to the treatment with thrombolytic therapy and anticoagulants enabled to achieve recovery in 433 (91.7 %) patients who were discharged for outpatient treatment. New oral anticoagulants were prescribed to 94 (21.7 %) patients after discharge.

scholarly journals A rare case of acute alcohol intoxication mimicking an electrocardiographic pattern for acute coronary syndrome with ST-segment elevation

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Franco Lai ◽  
Lorenzo Pelagatti ◽  
Chiara Pagnini ◽  
Alessio Baldini ◽  
Daniele Versari ◽  
...  
Keyword(s):  
Alcohol Intoxication ◽  
Coronary Spasm ◽  
Cyclic Guanosine Monophosphate ◽  
Guanosine Monophosphate ◽  
Pathophysiological Mechanism ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Threatening Condition ◽  
Life Threatening

A patient presenting an ST-segment elevation could represent a life-threatening condition in Emergency Department (ED). This case shows how sometimes, a chronic, and more often, an acute abuse of alcohol is related to important harmful effects on myocardial contractility. The authors present a case of a 19-year-old male of oriental-Asiatic origin admitted unconscious to ED with alcoholic fetor: on electrocardiogram a significant and widespread STsegment elevation was observed. A bedside echocardiography showed no abnormalities in segmental kinetics; therefore electrocardiogram- alterations could be related to a coronary spasm. The literature is poor about this effect induced by acute alcohol ingestion: the pathophysiological mechanism at the base of the abnormal muscle contractility, seems to be related to an impairment in cyclic guanosine monophosphate production, although a second and less probable hypothesis could be an altered intracellular concentration of calcium levels.

scholarly journals SIMPLE ELECTROCARDIOGRAPHIC CRITERIA FOR DISCRIMINATING BETWEEN ACUTE PULMONARY EMBOLISM AND ACUTE CORONARY SYNDROME

2016 ◽  
Vol 67 (13) ◽  
pp. 528 ◽  
Author(s):  
Masami Kosuge ◽  
Toshiaki Ebina ◽  
Kiyoshi Hibi ◽  
Kengo Tsukahara ◽  
Noriaki Iwahashi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Coronary Syndrome ◽  
Acute Pulmonary Embolism ◽  
Coronary Syndrome

scholarly journals A nasty surprise: cardiogenic shock induced by extensive dissection of the left internal mammary artery graft occurring 3 months after coronary angiography—a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Henning Ebelt ◽  
Peter Röhl ◽  
Andreas Schwenzky ◽  
Matthias Hoyme ◽  
Matthias Wiora
Keyword(s):  
Acute Coronary Syndrome ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Threatening Condition ◽  
Internal Mammary ◽  
Life Threatening ◽  
Acute Dissection

Abstract Background Acute dissection of the left internal mammary artery (LIMA) graft in patients with previous cardiac bypass surgery is a rare but potentially life-threatening condition. Case summary A 58-year-old man with history of coronary artery disease and bypass surgery 15 years ago presented with acute coronary syndrome (non-ST-elevation myocardial infarction, NSTEMI). Angiography showed severe three-vessel disease with occlusion of a saphenous vein graft (SVG) to the first diagonal branch but patents grafts to left artery descendent (LIMA) and SVG to the right coronary artery. No coronary intervention was performed and the patient was treated medically (aspirin and ticagrelor) and discharged home after 6 days. Three months later, the patient again was admitted to the hospital with acute coronary syndrome (NSTEMI) and developing cardiogenic shock. Angiography now showed an extensive flow limiting dissection of his LIMA graft with the dissection starting at the ostium of the LIMA. After implantation of an Impella 2.5, percutaneous coronary intervention (PCI) of the graft was performed under guidance by optical coherence tomography (OCT) leading to implantation of a drug-eluting stent into the ostium of the LIMA and repeated balloon dilatations of the medial and distal parts of the graft. Antegrade flow was established and the patient’s condition improved so that the Impella was removed in the cath lab. After an uneventful course, the patient was discharged home after 6 days. Elective repeat angiography after 8 weeks showed an excellent functional result without persisting signs of LIMA dissection or stenosis. Discussion Acute dissection of a LIMA graft is a rare event that may lead to a life-threatening condition. According to the literature, LIMA dissection happens during coronary interventions in approximately half of the cases but it also may evolve spontaneously. However, as seen from our case, there might be a substantial delay between LIMA angiography and the clinical onset of dissection. In the vast majority of cases, dissection of LIMA can be treated by PCI. The use of Impella as reported for the first time in this case may improve the safety of the procedure. In accordance to PCI of the native coronary arteries, it seems possible to leave non-flow limiting dissections in cases of extensive disease in order to avoid the late complications of complete stenting of the graft.

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