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Comments, Opinions, and Brief Case Reports
May 12, 2003

Right Ventricular Infarction in a Patient With Acute Pulmonary Embolism and Normal Coronary Arteries

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Arch Intern Med. 2003;163(9):1110-1111. doi:10.1001/archinte.163.9.1110

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.