Pulmonary embolism mimicking myocardial ischemia in an Emergency Department.

A man in his seventies presented to the Emergency Department with chest pain that mimicked myocardial ischemia but was ultimately caused by pulmonary embolism.

• He had sudden central chest pain radiating to both arms with diaphoresis.
• Observations, ECGs, and serial troponins were all normal.
• This is a single case report.

Targeted history taking revealed risk factors that pointed toward venous thromboembolism rather than a cardiac cause.

• The patient reported previous unilateral calf pain.
• He had recent long-haul travel.
• These details emerged only on targeted history, not from the initial presentation.

D-dimer was elevated and CT pulmonary angiography confirmed multiple segmental and subsegmental pulmonary emboli without right heart strain.

• Imaging showed multiple emboli at segmental and subsegmental levels.
• There was no evidence of right heart strain on imaging.

The patient was treated with therapeutic anticoagulation, later transitioned to apixaban for six months.

• Therapeutic anticoagulation was commenced after diagnosis.
• He was then transitioned to apixaban with a planned six-month duration.

The authors conclude that the case highlights the need for structured history taking and avoidance of diagnostic anchoring in emergency chest pain assessment.

• Normal ECGs and serial troponins could have anchored clinicians toward a non-cardiac or non-specific diagnosis.
• Targeted history identified the key clues leading to the correct diagnosis.