We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comments, Opinions, and Brief Case Reports |

Right Ventricular Infarction in a Patient With Acute Pulmonary Embolism and Normal Coronary Arteries

Piotr Pruszczyk, MD, PhD; Marcin Szulc, MD, PhD; Grzegorz Horszczaruk, MD; Hubert Gurba, MD, PhD; Malgorzata Kobylecka, MD
Arch Intern Med. 2003;163(9):1110-1111. doi:10.1001/archinte.163.9.1110.
Text Size: A A A
Published online


Acute pulmonary embolism (APE) is still one of the major causes of in-hospital mortality. Myocardial ischemia and even right ventricular (RV) infarction are found at autopsy in patients who die of massive APE. A case series reported transmural RV necrosis in 4 patients and subendocardial necrosis in 2 others.1 Therefore, it was suggested that myocardial damage of the right ventricle with its irreversible failure may be one of the mechanisms precipitating a fatal outcome. Recently, plasma levels of cardiac troponin T (cTnT)2 and cardiac troponin I (cTnI),3 markers of myocardial injury, were found to be elevated in some patients with APE. We describe a patient with massive APE and normal coronary arteries in whom RV strain caused myocardial injury and abnormal plasma troponin levels suggested an acute coronary syndrome.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.

Coronary angiography. A, No significant lesions are observed in the right coronary artery (RCA); TIMI (Thrombolysis in Myocardial Infarction) grade 3 flow is preserved. B, Diminished myocardial perfusion of the RCA with TIMI myocardial perfusion grade 2 (TMPG 2).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Heart scintigraphy with technetium Tc 99m pyrophosphate detected abnormal isotope uptake within the right ventricle and left ventricular inferior wall (omega sign), suggestive of acute myocardial damage. LAO indicates left anterior oblique plane.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

14 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Pulmonary Embolus

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Pulmonary Embolus