RESUMO
BACKGROUND: Acute pulmonary embolism (APE) is often misdiagnosed as acute coronary syndrome because of the similarity of the presenting symptoms and of the electrocardiogram (ECG) manifestations. In APE, ST-segment elevation (STE) in leads V1 to V3 /V4 , mimicking anteroseptal myocardial infarction, is not a rare phenomenon. Negative T waves (NTW) in the precordial leads mimicking the "Wellens' syndrome" is an important ECG manifestation of APE. The evolution of these ECG changes-STE and NTW-in APE has not been thoroughly studied. METHODS: We present two patient cases with APE and their evolving serial ECGs to analyze the correlation between STE and NTW. RESULTS: NTW developed later than STE in these two patient cases. CONCLUSIONS: NTW might represent a "postischemic" ECG pattern indicating a previous stage with transmural myocardial ischemia.