Acute massive pulmonary embolism mimicking non-ST-elevation acute coronary syndrome

Non-ST-elevation acute coronary syndrome frequently presents with negative T-wave inversion. In acute pulmonary embolism precordial T-wave inversion occurs due to right ventricular strain. We herein report a case of a 48-year-old woman presenting with syncope secondary to massive main pulmonary artery embolism which was initially diagnosed as acute coronary syndrome due to negative anterior T-wave inversion and raised troponin. In addition, her room air saturation was normal and electrocardiogram showed T-wave inversion in inferior wall leads as well. We present this case of massive pulmonary embolism with varied presentation which was initially misdiagnosed as acute coronary syndrome.