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• W2026398139 abstract "In a recent case report [ [1] Lin JF, Li YC, Yang PL: A case of massive pulmonary embolism with ST elevation in leads V1–4. J Circ, in press. Google Scholar ] of massive pulmonary embolism (PE) with ST-elevations in precordial leads V1–V4, the authors offered several possible explanations for this paradoxical pattern but failed to mention paradoxical coronary embolism as the most likely mechanism. In contrast to the usual ST depression in precordial leads V1–V4 from right heart strain, [ 2 Van Mieghem C. Sabbe M. Knockaert D. The clinical value of the ECG in noncardiac conditions. Chest. 2004; 125: 1561-1576 Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar , 3 Sreeram N. Cheriex E.C. Smeets J.L. Gorgels A.P. Wellens H.J. Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism. Am J Cardiol. 1994; 73: 298-303 Abstract Full Text PDF PubMed Scopus (159) Google Scholar ] patients with PE have occasionally shown ST elevations in the right to mid precordial leads on ECG [ 4 Romhilt D. Susilavorn B. Chou T.C. Unusual electrocardiographic manifestation of pulmonary embolism. Am Heart J. 1970; 80: 237-241 Crossref PubMed Scopus (19) Google Scholar , 5 Berman L. Schamroth L. Acute pulmonary embolism. Heart Lung. 1979; 8: 1146-1147 PubMed Google Scholar , 6 McLarin C.W. Latting C.A. Walter P.F. Wenger N.K. Pseudo anterior myocardial infarction as a manifestation of severe pulmonary embolism. J Med Assoc Ga. 1981; 70: 649-653 PubMed Google Scholar , 7 Falterman T.J. Martinez J.A. Daberkow D. Weiss L.D. Pulmonary embolism with ST segment elevation in leads V1 to V4: case report and review of the literature regarding electrocardiographic changes in acute pulmonary embolism. J Emerg Med. 2001; 21: 255-261 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar , 8 Vavricka S.R. Himmelmann A. Schaffner A. Brugada syndrome. Lancet. 2002; 360: 1913 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar , 9 Wang K. Asinger R.W. Marriott H.J.L. Current concepts: ST-segment elevation in conditions other than acute myocardial infarction. N Engl J Med. 2003; 349: 2128-2135 Crossref PubMed Scopus (477) Google Scholar ]. The most likely explanation is paradoxical coronary embolism secondary to PE [ 10 Cheng T.O. Paradoxical embolism. A diagnostic challenge and its detection during life. Circulation. 1976; 53: 565-568 Crossref Google Scholar , 11 Cheng T.O. Paradoxical emboli after pulmonary embolus. Presse Med. 1995; 24: 1049 PubMed Google Scholar , 12 Cheng T.O. Paradoxic embolism. Am Heart J. 1996; 131: 1238 Crossref PubMed Scopus (14) Google Scholar , 13 Cheng T.O. Coronary embolism. Am Heart J. 1996; 132: 1314-1315 Crossref PubMed Scopus (9) Google Scholar , 14 Cheng T.O. Paradoxical embolism: diagnosis and management. J Emerg Med. 2001; 20: 416-417 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar , 15 Cheng T.O. Right-sided chest-lead abnormalities on EKG in acute pulmonary embolism. J Nat Med Assoc. 2003; 95: 862 PubMed Google Scholar , 16 Cheng T.O. Brugada syndrome vs. pulmonary embolism vs. paradoxical embolism. What are we to believe?. Int J Cardiol. 2004; 94: 119 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 17 Cheng T.O. Role of paradoxic embolism in patients with acute pulmonary embolism and right ventricular enlargement who are at risk for adverse clinical events. Circulation. 2004; 110: e331 Crossref PubMed Scopus (5) Google Scholar , 18 Cheng T.O. Paradoxic coronary embolism as an alternative explanation for increased cardiac troponin in acute pulmonary embolism. 2004 Google Scholar , 19 Cheng T.O. Mechanism of ST elevation in acute pulmonary embolism. Int J Cardiol. 2005; 103: 221-223 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 20 Cheng T.O. Paradoxical embolism presenting as pulmonary embolism, transient ischemic attack and acute myocardial infarction. Int J Cardiol. 2009; 134: 110-111 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 21 Cheng TO Coronary embolism. Int J Cardiol. 2009; 136: 1-3 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar ]. Paradoxical embolism usually occurs in the setting of a sudden rise of right heart pressure, e.g., acute PE, or Valsalva maneuver during straining at defecation or cough, which causes a right-to-left shunt through a pre-existing patent foramen ovale or small atrial septal defect or atrial septal aneurysm [ 10 Cheng T.O. Paradoxical embolism. A diagnostic challenge and its detection during life. Circulation. 1976; 53: 565-568 Crossref Google Scholar , 11 Cheng T.O. Paradoxical emboli after pulmonary embolus. Presse Med. 1995; 24: 1049 PubMed Google Scholar , 12 Cheng T.O. Paradoxic embolism. Am Heart J. 1996; 131: 1238 Crossref PubMed Scopus (14) Google Scholar , 13 Cheng T.O. Coronary embolism. Am Heart J. 1996; 132: 1314-1315 Crossref PubMed Scopus (9) Google Scholar , 14 Cheng T.O. Paradoxical embolism: diagnosis and management. J Emerg Med. 2001; 20: 416-417 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar , 15 Cheng T.O. Right-sided chest-lead abnormalities on EKG in acute pulmonary embolism. J Nat Med Assoc. 2003; 95: 862 PubMed Google Scholar , 16 Cheng T.O. Brugada syndrome vs. pulmonary embolism vs. paradoxical embolism. What are we to believe?. Int J Cardiol. 2004; 94: 119 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 17 Cheng T.O. Role of paradoxic embolism in patients with acute pulmonary embolism and right ventricular enlargement who are at risk for adverse clinical events. Circulation. 2004; 110: e331 Crossref PubMed Scopus (5) Google Scholar , 18 Cheng T.O. Paradoxic coronary embolism as an alternative explanation for increased cardiac troponin in acute pulmonary embolism. 2004 Google Scholar , 19 Cheng T.O. Mechanism of ST elevation in acute pulmonary embolism. Int J Cardiol. 2005; 103: 221-223 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 20 Cheng T.O. Paradoxical embolism presenting as pulmonary embolism, transient ischemic attack and acute myocardial infarction. Int J Cardiol. 2009; 134: 110-111 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 21 Cheng TO Coronary embolism. Int J Cardiol. 2009; 136: 1-3 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar ]." @default.
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• W2026398139 title "Mechanism of ST-elevation in precordial leads V1–V4 in acute pulmonary embolism" @default.
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