Acute pulmonary embolism as the cause of global T wave inversion and QT prolongation. A case report.

A 57-year-old man without prior history of organic heart disease was admitted with a diagnosis of unstable angina because of chest pain and new electrocardiographic (ECG) changes of global T wave inversion and QT interval prolongation. Left and right heart catheterization with coronary angiography, pulmonary angiography, ventilation-perfusion scintigraphy, and echocardiography showed absence of coronary artery disease but unequivocally acute pulmonary embolism. Within days following anticoagulant therapy, the lengthened QT interval became normalized while the global T wave inversion persisted. A follow-up ECG 15 months later revealed complete resolution of the T wave inversion. The possible pathophysiologic mechanism of the ECG changes is discussed.