Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis?

In conclusion, the presence of negative T waves in both leads III and V1 allows PE to be differentiated simply but accurately from ACS in patients with negative T waves in the precordial leads."See this post for more detail on the ECG in pulmonary embolism.  Still more cases are here.The patient was treated for NonSTEMI, including ACS dosing of heparin and including nitroglycerin, which could be hazardous in pulmonary embolism.  He was admitted to cardiology where he immediately underwent an echocardiogram, which showed RV strain, alerting the clinicians to PE.  A CT pulmonary angiogram confirmed multiple pulmonary emboli.Strangely, there is no tachycardia and the patient was not on beta blockers.Lessons:1. Chest pain with a positive troponin may be due to many causes, not just ACS.  Always consider these.  2. Precordial T-wave inversion, along with a negative T-wave in lead III, should alert you to the strong possibility of pulmonary embolism.
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs