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Pulmonary Embolism Presenting as Coronary Insufficiency

Robert A. Shaw, MD; Steven A. Schonfeld, MD; Michael E. Whitcomb, MD
Arch Intern Med. 1981;141(5):651. doi:10.1001/archinte.1981.00340050097021.
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The clinical manifestations of pulmonary embolism are extremely varied. It is generally not appreciated that patients with central pulmonary embolism may have chest pain caused by coronary insufficiency. To emphasize this relationship, we describe two patients who were first observed in this manner.


Case1.  —A 72-year-old man was admitted to the hospital because of a two-week history of chest pain on exertion. The patient was tachypneic at rest. Otherwise, the physical examination's findings were unremarkable. Serial ECGs and cardiac enzymes did not evolve a pattern of acute myocardial infarction. Because of recurrent chest pain, a cardiac catheterization was done on the fifth hospital day. The coronary arteries were patent but the pulmonary artery pressure was 65/25 mm Hg. Pulmonary angiography demonstrated emboli in the right main pulmonary artery and in the artery to the left upper lobe. The patient was later discharged on a regimen of


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