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.