Obstructive shock presenting like STEMI: case report

Abstract

: Pulmonary emboli have varied clinical presentations and are largely determined by the size and position of these emboli. Symptoms include no symptoms at all, dyspnea, cough, or chest pain. Patients often also exhibit tachypnea and tachycardia. In more extreme cases, larger pulmonary emboli at the bifurcation of the pulmonary arteries called saddle emboli can lead to severe right heart failure and even death. Diagnosing emboli can be difficult because the constellation of symptoms discussed can also be attributed to other medical conditions like pneumothoraxes and pericarditis. For clinicians, it is paramount that prompt and accurate diagnosis of pulmonary emboli be done to facilitate expedient treatment for this condition. The Wells’ Criteria is a useful tool to stratify the risk that a patient has a pulmonary embolism. However, often patients can present with pulmonary emboli without the “typical” risk factors such as prolonged immobilization, surgery in the previous four weeks, hypercoagulable conditions, or asymmetric lower extremity swelling. We present a 66 years old African American male who arrived to the emergency department in shock and with initial electrocardiographic findings consistent with left main stenosis but catheterization findings consistent with negative coronary artery disease and was later found to have extensive bilateral pulmonary emboli.