{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:11:13Z","timestamp":1760130673852,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>The clinical presentation of pulmonary embolism (PE) and acute coronary syndrome can be similar. We report a case of a patient presenting with antero-septal ST-segment elevation after cardiac arrest, found to have acute-PE-mimicking ST-segment elevation myocardial infarction (STEMI), treated with aspiration thrombectomy and catheter-directed thrombolysis (CDT). A 78-year-old man was admitted with dyspnea, chest pain and tachycardia. During evaluation, cardiac arrest in pulseless electrical activity was documented. Advanced life support was started immediately. ECG post-ROSC revealed ST-segment elevation in V1\u2013V4 and aVR. Echocardiography showed normal left ventricular function but right ventricular (RV) dilation and severe dysfunction. The patient was in shock and was promptly referred to cardiac catheterization that excluded significant CAD. Due to the discordant ECG and echocardiogram findings, acute PE was suspected, and immediate invasive pulmonary angiography revealed bilateral massive pulmonary embolism. Successful aspiration thrombectomy was performed followed by local alteplase infusion. At the end of the procedure, mPAP was reduced and blood pressure normalized allowing withdrawal of vasopressor support. Twenty-four-hour echocardiographic reassessment showed normal-sized cardiac chambers with preserved biventricular systolic function. Bedside echocardiography in patients with ST-segment elevation post-ROSC is instrumental in raising the suspicion of acute PE. In the absence of a culprit coronary lesion, prompt pulmonary angiography should be considered if immediately feasible. In these cases, CDT and aspiration in high-risk acute PE seem safe and effective in relieving obstructive shock and restoring hemodynamics.<\/jats:p>","DOI":"10.3390\/jcdd10090374","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T08:45:31Z","timestamp":1693557931000},"page":"374","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["ST-Segment Elevation: An Unexpected Culprit"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6323-7801","authenticated-orcid":false,"given":"David","family":"S\u00e1 Couto","sequence":"first","affiliation":[{"name":"Cardiology Department, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal"},{"name":"ICBAS School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2465-2217","authenticated-orcid":false,"given":"Andr\u00e9","family":"Alexandre","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal"},{"name":"ICBAS School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal"}]},{"given":"Ricardo","family":"Costa","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5662-8433","authenticated-orcid":false,"given":"Andreia","family":"Campinas","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal"},{"name":"ICBAS School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal"}]},{"given":"Mariana","family":"Santos","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal"},{"name":"ICBAS School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal"}]},{"given":"Diana","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal"}]},{"given":"Severo","family":"Torres","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal"},{"name":"ICBAS School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal"}]},{"given":"Andr\u00e9","family":"Luz","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal"},{"name":"ICBAS School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal"},{"name":"Cardiovascular Research Group at Unidade Muldisciplinar de Investiga\u00e7\u00e3o Biom\u00e9dica (UMIB), ICBAS School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.jacc.2010.05.071","article-title":"Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: Initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry)","volume":"57","author":"Pollack","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/j.amjmed.2021.01.026","article-title":"Nineteen-Year Trends in Mortality of Patients Hospitalized in the United States with High-Risk Pulmonary Embolism","volume":"134","author":"Stein","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1056\/NEJMra022580","article-title":"ST-segment elevation in conditions other than acute myocardial infarction","volume":"349","author":"Wang","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1177\/1708538118791917","article-title":"Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction","volume":"27","author":"Villablanca","year":"2019","journal-title":"Vascular"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1476-7120-8-50","article-title":"Acute ECG st-segment elevation mimicking myocardial infarction in a patient with pulmonary embolism","volume":"8","author":"Goslar","year":"2010","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_8","first-page":"1364","article-title":"Randomized Trial Comparing Standard Versus Ultrasound-Assisted Thrombolysis for Submassive Pulmonary Embolism: The SUNSET sPE Trial","volume":"14","author":"Avgerinos","year":"2021","journal-title":"Cardiovasc. Interv."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1161\/CIRCULATIONAHA.113.005544","article-title":"Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism","volume":"129","author":"Kucher","year":"2014","journal-title":"Circulation"},{"key":"ref_10","first-page":"1382","article-title":"A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study","volume":"8","author":"Piazza","year":"2015","journal-title":"Cardiovasc. Interv."},{"key":"ref_11","first-page":"319","article-title":"Indigo Aspiration System for Treatment of Pulmonary Embolism: Results of the EXTRACT-PE Trial","volume":"14","author":"Sista","year":"2021","journal-title":"Cardiovasc. Interv."},{"key":"ref_12","first-page":"1401","article-title":"A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Risk Pulmonary Embolism: The OPTALYSE PE Trial","volume":"11","author":"Tapson","year":"2018","journal-title":"Cardiovasc. Interv."},{"key":"ref_13","first-page":"859","article-title":"A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism: The FLARE Study","volume":"12","author":"Tu","year":"2019","journal-title":"Cardiovasc. Interv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e927923-1","DOI":"10.12659\/AJCR.927923","article-title":"Pulmonary embolism presenting as st-elevation myocardial infarction: A diagnostic trap","volume":"21","author":"Siddiqa","year":"2020","journal-title":"Am. J. Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.ijcard.2004.08.078","article-title":"Mechanism of st-elevation in acute pulmonary embolism","volume":"103","author":"Cheng","year":"2005","journal-title":"Int. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e12928","DOI":"10.1111\/anec.12928","article-title":"A potential diagnostic pitfall in St Elevation: Acute pulmonary embolism or ST-segment elevation myocardial infarction","volume":"27","author":"Zheng","year":"2021","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_17","first-page":"e29249","article-title":"A rare case of pulmonary emboli presenting with ST Elevation on ECG","volume":"14","author":"Gheith","year":"2022","journal-title":"Cureus"},{"key":"ref_18","first-page":"bcr-2018","article-title":"Unusual presentation of Acute Pulmonary Embolus presenting with inferior St Elevation","volume":"2018","author":"Mistry","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1056\/NEJMoa1302097","article-title":"Fibrinolysis for patients with intermediate-risk pulmonary embolism","volume":"370","author":"Meyer","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e623","DOI":"10.4244\/EIJ-D-22-00246","article-title":"Percutaneous treatment options for acute pulmonary embolism: A clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions","volume":"18","author":"Pruszczyk","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.amjcard.2022.06.004","article-title":"Meta-Analysis Comparing Catheter-Directed Thrombolysis Versus Systemic Anticoagulation Alone for Submassive Pulmonary Embolism","volume":"178","author":"Ismayl","year":"2022","journal-title":"Am. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1001\/jamacardio.2022.3591","article-title":"Catheter-Directed Thrombolysis vs Anticoagulation in Patients with Acute Intermediate-High-risk Pulmonary Embolism: The CANARY Randomized Clinical Trial","volume":"7","author":"Sadeghipour","year":"2022","journal-title":"JAMA Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1093\/eurheartj\/ehu218","article-title":"Systemic thrombolytic therapy for acute pulmonary embolism: A systematic review and meta-analysis","volume":"36","author":"Marti","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ijcard.2019.02.061","article-title":"Catheter-directed aspiration thrombectomy and low-dose thrombolysis for patients with acute unstable pulmonary embolism: Prospective outcomes from a PE registry","volume":"287","author":"Guirola","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.4244\/EIJ-D-22-00732","article-title":"Acute outcomes for the full US cohort of the Flash mechanical thrombectomy registry in Pulmonary Embolism","volume":"18","author":"Toma","year":"2023","journal-title":"EuroIntervention"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/9\/374\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:44:40Z","timestamp":1760129080000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/9\/374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,1]]},"references-count":25,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["jcdd10090374"],"URL":"https:\/\/doi.org\/10.3390\/jcdd10090374","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2023,9,1]]}}}