Malaysian Applied Biology Journal

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47_01_12

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Malays. Appl. Biol. (2018) 47(1): 81–88

 

DIAGNOSTIC CONSIDERATION IN CASES OF PULMONARY

EMBOLISM MIMICKING ACUTE CORONARY SYNDROME:

IS ELECTROCARDIOGRAPHY A FRIEND OR A FOE?

 

KENG SHENG CHEW1*, ELISE CHUI KING WONG2, NARIMAN SINGMAMAE1, AARON KH LAI2

and SERI DIANA MAHMUD AFFANDI2


1Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak,

94300 Kota Samarahan, Sarawak

2Emergency Medicine and Trauma Department, Sarawak General Hospital,

Jalan Hospital, 93586 Kuching, Sarawak, Malaysia

*E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 

Accepted 15 February 2018, Published online 31 March 2018

 

ABSTRACT

Objectives: As the clinical presentations of pulmonary embolism (PE) closely mimic that of acute coronary syndrome (ACS), the purpose of this brief report is to study the effect of adding an electrocardiography tracing (ECG) suggestive of ACS on the diagnostic consideration of PE with chest pain presentation. Methods: Twenty final year medical students and 31 house officers randomized to one of two cases of PE patients presented with clinical and ECG suggestive of ACS. Each of these two cases was divided further into either with ECG tracing attached or without. Results: More participants without ECG attached had considered PE as a differential diagnosis vs those provided with ECG (8 out of 25, 32% vs. 6 out of 26, 23% respectively, p=0.48). Specifically for the first case, the consideration of PE as a differential diagnosis was significantly higher when ECG was not attached compared to when it was attached (4 out of 13 or 30.8% vs. 0 out of 14, p = 0.04). Conclusion: In cases where the clinical signs and symptoms mimic that of an ACS, performing an ECG with features mimicking ACS may not only be unhelpful, but may paradoxically deter consideration of PE.

Key words: Acute coronary syndrome, diagnosis, electrocardiography, pulmonary embolism

 

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