ST elevation and tension pneumothorax

We present a case of a sixty-nine-year-old male admitted to the hospital be cause of an acute respiratory failure that needed intubation and mechanical ventilation. Shortly after several attempts of right and left (the last on e succesful) subclavian vein cannulation (the last one successful) he devel oped a bilateral tension pneumothorax with important hemodynamic repercussi on, a critical hypoxia and an ST elevation in inferior leads. Other more ty pical electrocardiographic changes could be observed: decrease in QRS ampli tude and diminishing of precordial R voltage. After removing the air of the right pleural space, all the electrocardiographic signs disappeared return ing to normal without electric or enzimatic assay of myocardial necrosis.