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.
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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).
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.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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