PMC10442817_01
(A) ECG obtained at the local hospital. The findings suggest that the patient has been diagnosed with third-degree atrioventricular block. In addition, there are significant ST segment elevations observed in leads II, III, and aVF, and inverted T waves seen in leads V1-V6, accompanied by ST-segment depression. (B) ECG obtained at the emergency department of our hospital. The findings suggest that the patient has a sinus rhythm. There are inverted T waves observed in leads V1-V4, accompanied by a lesser degree of ST-segment depression. (C) ECG obtained at the Department of Cardiology of our hospital. The findings indicate left ventricular high voltage. There is a resolution observed in the ST segments of leads II, III, and aVF.
fcvm-10-1013727-g001.jpg
PMC10442817_01_fcvm-10-1013727-g001.jpg
F1
The ECG obtained at the local hospital showed ST-segment elevation in the inferior wall leads (II, III, and aVF), indicating possible damage to the heart muscle in that area and a complete atrioventricular block (Figure 1A). When the patient arrived at our emergency department, another ECG was performed, which showed a sinus rhythm with ST-segment elevation in the inferior wall leads (Figure 1B). At this point, ST segments of the inferior wall leads displayed resolution (Figure 1C), and the patient stated that the chest pain had subsided.
(A-C) General cranial computed tomography scan. A 3.3 x 2.3-cm left thalamic hematoma (red circle) is visible, with minimal surrounding edema. There is no evidence of midline shift. (D-F) Chest computed tomography scan. Scattered infection foci in bilateral lungs (especially in the lower lobes of both lungs), thickened bilateral pleura, right lower lobe atelectasis, right pleural effusion, and suspected pulmonary infarction can be seen. The pulmonary artery trunk is enlarged (red arrow).
fcvm-10-1013727-g002.jpg
PMC10442817_01_fcvm-10-1013727-g002.jpg
F2
MB (CK-MB) level, 108.00 ng/ml; and brain natriuretic peptide level, 264 pg/ml. Moreover, the patient underwent general cranial computed tomography (CT) scans (Figures 2A-C) and chest CT scans (Figures 2D-F) to assess any further complications or conditions.
(A-C) Computed tomography coronary angiography scan. Calcification can be seen in the left anterior descending artery (red circle), and no other abnormalities were observed. (D-F) Computed tomography pulmonary angiography scan. The main findings revealed the presence of thrombi in the right upper lobe, right lower lobe, and left lower lobe. (H-J) Coronary angiography scan. The scan indicates that there are no significant narrowings or stenosis observed in either the left or right coronary arteries.
fcvm-10-1013727-g003.jpg
PMC10442817_01_fcvm-10-1013727-g003.jpg
F3
Surprisingly, the CTCA scan showed no signs of coronary artery occlusion or severe stenosis (Figures 3A-C). To confirm this diagnosis, a computed tomography pulmonary angiography (CTPA) was performed (Figures 3D-F), and the diagnosis of PE was confirmed. Furthermore, the CAG results revealed no significant stenosis in the coronary arteries (Figures 3H-3J).