Correlation between ST-segment elevation and negative T waves in the precordial leads in acute pulmonary embolism: insights into serial electrocardiogram changes.

Background Acute pulmonary embolism (APE) is often misdiagnosed as acute coronary syndrome because of the similarity of the presenting symptoms and of the electrocardiogram (ECG) manifestations. In APE, ST-segment elevation (STE) in leads V1 to V3/V4, mimicking anteroseptal myocardial infarction, is not a rare phenomenon. Negative T waves (NTW) in the precordial leads mimicking the “Wellens’ syndrome” is an important ECG manifestation of APE. The evolution of these ECG changes–STE and NTW–in APE has not been thoroughly studied. Methods We present two patient cases with APE and their evolving serial ECGs to analyze the correlation between STE and NTW. Results NTW developed later than STE in these two patient cases. Conclusions NTW might represent a “postischemic” ECG pattern indicating a previous stage with transmural myocardial ischemia.