Global T waves inversion and QT prolongation. An uncommon presentation of acute pulmonary embolism

This is the case of a man presenting to the emergency department for dyspnea. Despite a very common symptom he presented an uncommon twelve leads electrocardiogram (ECG). At a first glance it could have suggested an acute coronary syndrome, a Takotsubo cardiomyopathy or a hypertrophic cardiomyopathy. However the further investigations showed an acute pulmonary embolism (APE) whose pre-test probability was low with a Wells score of 0 and a Geneva simplified score of 1. Negative T waves have been described in APE, however, such a morphology associated with QT prolongation is a very rare presentation. This case confirms how the diagnosis of APE could be often insidious representing a challenge for the emergency physician.