Pulmonary embolism mimicking anteroseptal acute myocardial infarction.

Pulmonary embolism (PE) is a potentially lethal condition that presents in patients with chest pain or shortness of breath. Although electrocardiograms (ECGs) typically demonstrate abnormalities associated with PE, ST-segment elevation, which can indicate anteroseptal acute myocardial infarction (AMI), has-on rare occasions-been noted on ECGs of patients with acute PE. The current report documents the case of a 57-year-old man who presented to the emergency department with chest pain. Findings from an ECG suggested anteroseptal AMI; however, cardiac catheterization indicated that the patient did not have critical ischemic heart disease. On further examination, the patient was found to have a massive bilateral PE. The present report emphasizes that physicians must investigate PE in all patients presenting with chest pain, dyspnea, or both, even in the face of ECG changes that are suggestive of a cardiac etiology. A brief discussion of the current theories of ST-segment elevation in the setting of PE is also included.

Accuracy of multislice computed tomography coronary angiography: a pooled estimate.

A PUBMED search was performed for peer-reviewed studies published in English from 2002 through August 2006. Accuracy parameters for detection of obstructive coronary artery disease by MSCT (multislice computed tomography) coronary angiography were analyzed on patient and segment basis. Pooled estimates of sensitivity (SN), specificity, positive predictive value, and negative predictive value (NPV) in patient-based analyses were 93%, 82%, 83%, and 92%, respectively. For 64/40-slice MSCT the respective accuracy estimates were 96%, 91%, 93%, and 96% and were better compared with 16-slice MSCT. Also, more segments were evaluated by 64-slice MSCT (96%) compared with 16-slice MSCT (86%). The SN and NPV of MSCT coronary angiography for patients with low coronary artery calcium (CAC) score were 92% and 99% compared with 77% and 89% for patients with high CAC score. The accuracy estimates for MSCT in studying coronary artery by-pass grafts and intracoronary stents showed a SN and NPV of 97% and 97% for graft occlusion or stenosis and only 71% and 93% respectively for in-stent restenosis. Diagnostic accuracy of MSCT coronary angiography has improved with the newer 64-slice versions. High CAC scores can affect the accuracy of MSCT coronary angiography. Although the accuracy of MSCT in evaluating native vessel and graft disease has improved significantly, its reliability in studying intracoronary stents remains uncertain.

Noninvasive cardiac imaging with computed tomography.

Despite major improvements in the treatment of heart disease, it remains a major source of morbidity and mortality on a global scale. Currently, invasive coronary angiography remains the gold standard for identification of obstructive coronary artery disease. However, recent advances in computerized tomographic (CT) techniques of the heart allow for accurate, noninvasive characterization of atherosclerotic coronary disease and other cardiac abnormalities. The calculation of coronary artery calcium scores with electron beam CT has largely been supplanted by high-resolution CT angiography using multislice detectors (MSCT) which can provide detailed multidimensional visualization of cardiac structures. Although evaluation of obstructive coronary disease is the primary use of MSCT, its use in identifying congenital defects, planning thoracic procedures and characterizing cardiac function continues to grow. Accordingly, appropriate incorporation of MSCT/CT angiography into clinical practice continues to be defined. Several limitations to MSCT remain which reduce its accuracy, such as in patients with arrhythmia and in patients with either coronary stents or heavily calcified coronaries. Despite its current limitations, MSCT remains a rapidly advancing field and an increasingly valuable tool for the noninvasive evaluation of cardiac pathology.