Presumed Acute Coronary Syndrome in a Patient With Bilateral Pulmonary Embolism

Background: Acute pulmonary embolism (PE) represents a significant cause of cardiovascular mortality, requiring rapid intervention often preceding definitive diagnosis. While traditional risk factors, including immobilization, malignancy, and thrombophilia, are well-established, PE rarely presents as a diagnostic mimic of acute coronary syndrome (ACS). Methods: We present a case of a 59-year-old male patient with symptoms and electrocardiogram (ECG) findings highly suggestive of ACS. Emergency left heart catheterization revealed no obstructive coronary artery disease (CAD). Subsequent computed tomography (CT) angiography of the chest identified extensive bilateral pulmonary emboli involving the segmental arteries. Retrospective history revealed recent prolonged immobilization as the primary provocative factor. Results: The patient was stabilized and transitioned to oral anticoagulation (apixaban). He was discharged in stable condition for outpatient cardiovascular follow-up. Conclusion: PE-induced right ventricular strain can manifest with ECG changes that closely simulate ACS, posing a significant diagnostic challenge. Physicians should consider PE in patients presenting with atypical ACS features. Standardizing management protocols for PE-associated cardiac strain should be considered to prevent diagnostic delay and optimize clinical outcomes.