ST-elevation and complete heart block: A rare presentation of pulmonary embolism

ABSTRACT

Pulmonary embolism may present with nonspecific symptoms that overlap with acute coronary syndrome, including chest pain, shortness of breath, and palpitations. Common electrocardiogram findings include sinus tachycardia and right bundle branch block, whereas ST-segment elevation and complete heart block are rare. We report a case of a 77-year-old man who initially presented with transient complete heart block and ST-segment elevation on electrocardiography, raising concern for acute coronary syndrome. Left heart catheterization showed no significant obstructive coronary artery disease.

Computed tomography pulmonary angiography revealed a saddle pulmonary embolism, suggesting that thromboembolic disease was the primary cause of the electrocardiographic changes. Clinicians should maintain a high index of suspicion for pulmonary embolism in patients with abnormal electrocardiographic findings and relevant risk factors to avoid missing this potentially life-threatening diagnosis.

Keywords: Pulmonary embolism, Electrocardiography, Embolism, Heart Block