Tromboembolismo pulmonar o infarto de ventrículo derecho: Dilema clínico, a propósito de un caso

Pulmonary embolism is a cardiovascular emergency that it is often difficult to diagnose. The case of a 44-year-old male is reported. After an abdominal surgery, he presented with hemodynamic instability symptoms which were interpreted as a pulmonary thromboembolism. However, the finding of ST segment elevation in right precordial leads stirred clinically suspicion of right ventricular infarction. The absence of coronary lesions in the invasive coronary angiography and the evidence of pressure overload in the right ventricle, and thrombosis of the lower limbs, corroborated the initial diagnosis. This case emphasizes that this disease should be suspected in all patients with suggestive symptoms, even in the presence of electrocardiographic findings suggestive of myocardial infarction, especially in the absence of involvement of coronary circulation and echocardiographic evidence of right ventricular dysfunction associated with signs of pulmonary hypertension.El tromboembolismo pulmonar es una emergencia cardiovascular que a menudo es difícil de diagnosticar. Se presenta el caso de un hombre de 44 años que, posterior a una intervención quirúrgica abdominal, presentó un cuadro de inestabilidad hemodinámica interpretado como tromboembolismo pulmonar, pero el hallazgo de supradesnivel del ST en precordiales derechas determinó la sospecha clínica de un infarto de miocardio de ventrículo derecho. La ausencia de lesiones coronarias en el estudio coronariográfico invasivo y la presencia de evidencias de sobrecarga de presión en el ventrículo derecho, así como de trombosis de miembros inferiores, corroboraron el diagnóstico inicial. Este caso enfatiza que esta enfermedad debe ser sospechada en todo paciente con clínica sugestiva, incluso en presencia de hallazgos electrocardiográficos sugestivos de infarto de miocardio, sobre todo en ausencia de compromiso de la circulación coronaria y de evidencia ecocardiográfica de disfunción del ventrículo derecho asociado a signos de hipertensión pulmonar

Pulmonary embolism or right ventricular infarction: Clinical dilemma, apropos of a case

Pulmonary embolism is a cardiovascular emergency that it is often difficult to diagnose. The case of a 44-year-old male is reported. After an abdominal surgery, he presented with hemodynamic instability symptoms which were interpreted as a pulmonary thromboembolism. However, the finding of ST segment elevation in right precordial leads stirred clinically suspicion of right ventricular infarction. The absence of coronary lesions in the invasive coronary angiography and the evidence of pressure overload in the right ventricle, and thrombosis of the lower limbs, corroborated the initial diagnosis. This case emphasizes that this disease should be suspected in all patients with suggestive symptoms, even in the presence of electrocardiographic findings suggestive of myocardial infarction, especially in the absence of involvement of coronary circulation and echocardiographic evidence of right ventricular dysfunction associated with signs of pulmonary hypertension