ST-segment elevation mimicking inferior wall myocardial infarction in acute pulmonary thromboembolism: a case report

Abstract ST-segment elevation on electrocardiography (ECG) is classically associated with acute myocardial infarction but may rarely be seen in acute pulmonary thromboembolism (PTE). Such presentations pose a significant diagnostic challenge and may lead to inappropriate or delayed management. We report the case of a 44-year-old man who presented with acute chest tightness, severe hypoxaemia, shock, and ECG changes suggestive of inferior wall myocardial infarction. Subsequent evaluation revealed massive PTE with right ventricular (RV) dysfunction. The patient improved following systemic thrombolysis. This case highlights the importance of considering acute PTE in the differential diagnosis of ST-segment elevation, particularly in the presence of hypoxaemia and RV strain and discusses the possible pathophysiological mechanisms underlying these ECG changes.