Pulmonary embolism presenting with evolving electrocardiographic abnormalities mimicking anteroseptal myocardial infarction: a case report

To report a case with dynamic ST segment elevation suggestive of anteroseptal acute myocardial infarction [AMI] that proved to be bilateral pulmonary thromboembolism [PTE]. A 50-year-old woman with syncope was transferred to the emergency department. Findings from the admission electrocardiogram were suggestive of anteroseptal AMI; however, coronary angiography revealed that the patient had normal coronary arteries. On further evaluation, the patient was found to have massive bilateral PTE. This report emphasizes the role of evolving electrocardiographic changes in the diagnosis of PTE, particularly in patients with chest pain and ST segment elevation suggestive of acute coronary syndrome

role of surface ECG and transthoracic echocardiography for predicting postoperative atrial fibrillation after coronary artery bypass surgery

To evaluate the roles of surface electrocardiogram ECG and transthoracic echocardiography ECHO for prediction of atrial fibrillation AF after coronary artery bypass grafting CABG. This study was conducted from 2002-2004 at the Cardiovascular Department of Hacettepe University, Ankara, Turkey. Seventy consecutive patients were enrolled in this study that underwent elective CABG. A 12-lead ECG was recorded one day before cardiac surgery and was repeated during the 5 days after CABG. P-wave dispersion PWD was defined as the difference between maximum and minimum P-wave duration. Differences in P-wave duration were compared between the pre- and postoperative 12-lead ECG measurements. Postoperative AF developed in 17 24% cases of 70 patients. The PWD was found to be significantly higher in patients with AF preoperatively 60 +/- 19 versus 47 +/- 13, p=0.003, postoperative first day 56 +/- 12 versus 44 +/- 11, p<0.002 and fifth day 51 +/- 29 versus 41 +/- 11, p<0.001. Patients with AF were significantly older, the mean age of the AF group was 68 +/- 7 years and of the sinus rhythm SR group was 59 +/- 10 years p<0.001. The AF group had left ventricular systolic dysfunction 56 +/- 13% versus 56 +/- 8%, p=0.042, preoperatively; 49 +/- 8% versus 60 +/- 10%, p=0.001, postoperatively and a larger left atrium 46 +/- 5 versus 39 +/- 5 mm, p<0.001, preoperatively and 44 +/- 7 versus 39 +/- 5 mm, p=0.046, postoperatively than the SR group. This prospective study demonstrated that PWD on surface ECG and additional echocardiographic parameters are simple and reliable indexes to predict the development of AF after CABG