ST segment elevation in right precordial leads as a sign of massive pulmonary thromboembolism

Pulmonary thromboembolism (PTE) is a major cause of cardiovascular mortality that can present with nonspecific symptoms leading to delay in diagnosis and initiation of therapy. The electrocardiogram (ECG) is one of the first examination to be performed in cases of suspected PTE. ECG abnormalities can be seen, varying from the typical S1Q3T3 pattern to no specific changes. However, only very rarely does a PTE produce an ECG pattern mimicking ST-segment elevation myocardial infarction. We present a case with resuscitated out-of-hospital cardiac arrest showing a ST-segment elevation in leads V1-V4. Coronary angiography showed coronary arteries without lesions and pulmonary angiography showed a massive PTE. We describe the changes of the ECG and the importance of the recognition of ST-segment elevation in right precordial leads as sign of massive PTE.