Pulmonary embolism or right ventricular infarction: Clinical dilemma, apropos of a case

Abstract

Pulmonary embolism is a cardiovascular emergency that it is often difficult to diagnose. The case of a 44-year-old male is reported. After an abdominal surgery, he presented with hemodynamic instability symptoms which were interpreted as a pulmonary thromboembolism. However, the finding of ST segment elevation in right precordial leads stirred clinically suspicion of right ventricular infarction. The absence of coronary lesions in the invasive coronary angiography and the evidence of pressure overload in the right ventricle, and thrombosis of the lower limbs, corroborated the initial diagnosis. This case emphasizes that this disease should be suspected in all patients with suggestive symptoms, even in the presence of electrocardiographic findings suggestive of myocardial infarction, especially in the absence of involvement of coronary circulation and echocardiographic evidence of right ventricular dysfunction associated with signs of pulmonary hypertension.