Pulmonary embolism mimicking myocardial ischemia in an Emergency Department

Abstract

Presentation
A man in his seventies presented with sudden central chest pain radiating to both arms with diaphoresis. Observations, ECGs, and serial troponins were normal.

Diagnosis
Targeted history revealed previous unilateral calf pain and recent long-haul travel. D-dimer was elevated and CT pulmonary angiography confirmed multiple segmental and sub segmental pulmonary emboli without right heart strain.

Treatment
Therapeutic anticoagulation was commenced and later transitioned to apixaban for six months.

Discussion
This case highlights the need for structured history taking and avoidance of diagnostic anchoring in emergency chest pain assessment.