An 84-year-old woman, affected by Alzheimer's disease, presented to the emergency department with intense dyspnoea. Since ECG was showing T wave inversion in anterior leads and troponin-T was high, the patient was admitted to our unit with a diagnosis of anterior non-ST elevation myocardial infarction. However, the patient's medical history and a further review of the ECG led us to suspect a pulmonary embolism (PE) as a possible differential clinical diagnosis. We tested this alternative hypothesis: echocardiography as well as contrast-enhanced CT scan confirmed the diagnosis of PE. We describe these misleading ECG findings together with a brief discussion of electrocardiographical changes in pulmonary embolism.
Mirijello, A., Pola, R., Saviano, L., Landolfi, R., V1-V2-V3-V4 T wave inversion: left or right ventricle?, <<BMJ CASE REPORT>>, 2013; 2013 (Ottobre): 200331-200331. [doi:10.1136/bcr-2013-200331] [http://hdl.handle.net/10807/51195]
V1-V2-V3-V4 T wave inversion: left or right ventricle?
Mirijello, Antonio;Pola, Roberto;Saviano, Luisa;Landolfi, Raffaele
2013
Abstract
An 84-year-old woman, affected by Alzheimer's disease, presented to the emergency department with intense dyspnoea. Since ECG was showing T wave inversion in anterior leads and troponin-T was high, the patient was admitted to our unit with a diagnosis of anterior non-ST elevation myocardial infarction. However, the patient's medical history and a further review of the ECG led us to suspect a pulmonary embolism (PE) as a possible differential clinical diagnosis. We tested this alternative hypothesis: echocardiography as well as contrast-enhanced CT scan confirmed the diagnosis of PE. We describe these misleading ECG findings together with a brief discussion of electrocardiographical changes in pulmonary embolism.
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