Acute pulmonary embolism (APE) is still one of the major causes of in-hospital mortality. Myocardial ischemia and even right ventricular (RV) infarction are found at autopsy in patients who die of massive APE. A case series reported transmural RV necrosis in 4 patients and subendocardial necrosis in 2 others.1 Therefore, it was suggested that myocardial damage of the right ventricle with its irreversible failure may be one of the mechanisms precipitating a fatal outcome. Recently, plasma levels of cardiac troponin T (cTnT)2 and cardiac troponin I (cTnI),3 markers of myocardial injury, were found to be elevated in some patients with APE. We describe a patient with massive APE and normal coronary arteries in whom RV strain caused myocardial injury and abnormal plasma troponin levels suggested an acute coronary syndrome.
Pruszczyk P, Szulc M, Horszczaruk G, Gurba H, Kobylecka M. Right Ventricular Infarction in a Patient With Acute Pulmonary Embolism and Normal Coronary Arteries. Arch Intern Med. 2003;163(9):1110-1111. doi:10.1001/archinte.163.9.1110