Left Ventricular Myocardial Injury and Syncope due to Pulmonary Embolism in a Soldier: Normal Coronaries and Novel Pathologic Electrocardiogram Signs

Abstract

We present a soldier with a pulmonary embolism presenting with syncope during an ischemic stress test, subsequently found to have normal coronary arteries (CA). A 49-year-old soldier had 3 months history of exertional chest pain, shortness of breath, syncope, and malaise. He passed out during a stress echocardiogram and had a positive troponin level. A subsequent cardiac catheterization revealed normal CA but with mild hypokinesis of the distal anterior wall with a left ventricular ejection fraction of 44%. A subsequent nuclear ventilation-perfusion scan was consistent with bilateral pulmonary embolism. A Doppler ultrasound revealed thrombosis in the distal superficial femoral vein of the left leg. Hypercoagulable state markers were normal. This case demonstrates that a pulmonary embolism could express itself as an ST depression myocardial ischemic event perhaps by affecting the coronary flow to the left anterior descending CA.