Pulmonary Emboli Mimicking ST-Elevation Myocardial Infarction Patterns

A pulmonary embolism (PE) is a serious condition characterized by obstruction of the pulmonary arteries, often presenting with symptoms such as sudden shortness of breath and chest pain. While pulmonary emboli and ST-segment elevation myocardial infarctions (STEMI) are distinct clinical entities, they can present with similar electrocardiogram (ECG) findings, complicating diagnosis and management. This study presents two case reports of patients who exhibited ECG changes resembling STEMI but were ultimately diagnosed with PE via CT angiography (CTA). The first case involved a 67-year-old female with a history of knee surgery and recent immobility, presenting with ST elevation in leads V1 and V2, whose CTA revealed bilateral segmental pulmonary emboli with right heart strain. The second case involved a 55-year-old female with COPD and recent surgery, presenting with ST elevation in lead aVR and V1, whose CTA also confirmed bilateral pulmonary emboli with right heart strain. The cases demonstrate the need for comprehensive clinical evaluation and advanced imaging to distinguish between PE and STEMI, especially in patients with risk factors for venous thromboembolism (VTE). We also aimed to explore potential mechanisms underlying the ECG similarities, including right ventricular strain and Connexin-43 (Cx43) dysregulation. The goal of the study is to highlight how an acute PE can mimic a STEMI and highlight the diagnostic challenge in a patient with this presentation.