Saddle Pulmonary Embolism Presenting as Inferior ST-Elevation

Massive pulmonary embolism (PE) is a well-recognized cause of obstructive shock and cardiac arrest, accounting for an estimated 5–10% of sudden cardiac deaths. Although PE classically presents with sinus tachycardia or nonspecific EKG findings, acute right ventricular (RV) strain can produce ST-segment elevations that mimic acute myocardial infarction, particularly following return of spontaneous circulation (ROSC). These pseudo-STEMI patterns are thought to arise from RV ischemia due to acute pressure overload, hypoxia, and decreased coronary perfusion. Early differentiation between PE and true coronary occlusion is critical, as management pathways diverge significantly and delays in definitive therapy may worsen outcomes. Point-of-care ultrasound (POCUS) offers rapid bedside assessment of RV structure and function and may be particularly valuable when traditional diagnostic modalities are unavailable or misleading during resuscitation.