case_images: PMC10876825_01
case_images: Serial changes of recorded 12-lead electrocardiogram (ECG). (A) The initial ECG shows a complete atrioventricular block (CAVB) with right bundle branch block. (B) The immediate post-thrombolytic ECG with unresolved CAVB. (C) Normal sinus rhythm with left bundle branch block at 88 beats per minute.
case_images: fcvm-11-1355000-g001.jpg
case_images: PMC10876825_01_fcvm-11-1355000-g001.jpg
case_images: F1
case_images: T-wave inversions in lead V1-V3 (Figure 1A). The patient had no known history of underlying arrhythmias or cardiac problems related to acute changes in hemodynamic collapse. CAVB with complete RBBB (Figure 1B) and RV dysfunction persisted as documented via echocardiography. Considering the persistent symptoms and remaining signs of high-risk acute PE even after thrombolytic therapy, we decided to insert a temporary transvenous pacemaker. A subsequent ECG revealed the presence of a baseline left bundle branch block (LBBB) that had not been documented previously (Figure 1C).
case_images: Computed tomographic pulmonary angiography indicating pulmonary emboli in the distal left main pulmonary artery.
case_images: fcvm-11-1355000-g002.jpg
case_images: PMC10876825_01_fcvm-11-1355000-g002.jpg
case_images: F2
case_images: Computed tomographic pulmonary angiography (CTPA) revealed an enlarged right ventricle (RV) with multiple filling defects in the distal left main pulmonary artery that extended into both lobar and segmental pulmonary arteries of both lungs (Figure 2).