Patient presented with non-specific symptoms such as dyspnea and tachycardia. After a prolonged flight, he had swelling of lower limb. He had h/o DVT 3 years back. Laboratory investigations revealed raised inflammatory markers. ECG showed a RBBB. hs TnT kinetic pattern showed a rise and fall within 48hours. Pulmonary imaging showed multiple thromboembolic events. Clinical context needs to be considered before reaching a diagnosis in this case.
It is not always possible to differentiate between acute myocardial infarction (except by definition in STEMI) and other diseases with acute cardiac involvement such as pulmonary embolism and ventricular tachyarrhythmias, which require the work-up of differential diagnoses.1
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Diagnosis
Acute pulmonary embolism
This patient presents the typical clinical features and has an indicative history following a prolonged flight. Typical ECG changes with sinus tachycardia, SI-QIII type, right bundle-branch block are observed. The angiographic CT scan (256-slice CT) shows multiple thromboembolic events (red arrows) bilaterally. The cTnT-hs levels display an acute kinetic profile with a rapid rise followed by a fall. The clinical context is the key element to consider for a differential diagnosis of acute non-STEMI.
Conclusion
The clinical features do not suggest a diagnosis of AMI.
References
- Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. non-coronary disease. Eur Heart J. 2011; 32: 404–11