CHEST Guidelines-A-Woman-in-Her-80s-With-Anterior-ST-Elevation-Myoc

A-Woman-in-Her-80s-With-Anterior-ST-Elevation-Myoc

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The document details a medical case involving a woman in her 80s who presented with chest pain and shock, initially thought to be due to an ST-segment elevation myocardial infarction (STEMI), specifically an anterior wall infarction. She was transported for primary percutaneous coronary intervention. On arrival, she was in Killip class IV shock, necessitating medication to maintain blood pressure, and significant ECG changes were noted, suggesting a proximal left anterior descending artery lesion.<br /><br />Angiography confirmed a 95% lesion in the artery, and a bare metal stent was placed. However, an echocardiogram (FoCUS) showed a flattened septum and right ventricular pressure overload, indicating a possible pulmonary embolism (PE) rather than solely a coronary artery issue.<br /><br />Subsequent scans revealed a mass in the right atrium, initially thought to be a thrombus indicating PE. A CT scan confirmed bilateral pulmonary emboli, and the thrombus in the right atrium had resolved, suggesting it had moved to the pulmonary arteries. This case demonstrates how PE can mimic a heart attack and highlights the diagnostic value of routine FoCUS to differentiate between similar presentations of cardiovascular issues.<br /><br />The case underscores the importance of using FoCUS alongside history and physical examinations to improve diagnostic accuracy, potentially leading to better treatment outcomes by identifying unexpected conditions like PE, which can present with symptoms similar to myocardial infarctions. This approach can significantly impact treatment and prognosis by revealing alternative causes of chest pain and shock.

Keywords

pulmonary embolism

myocardial infarction

FoCUS

diagnostic accuracy

coronary intervention

right atrium thrombus

chest pain

shock

ECG changes

treatment outcomes