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Variable ECG findings associated with pulmonary embolism

An elderly man with a recent diagnosis of invasive rectal adenocarcinoma was admitted to the hospital because of a lower gastrointestinal bleeding and low haemoglobin. During the hospitalisation he complained of chest pain. ECG showed new onset ST-segment elevation in leads III, aVF and in the precordial leads V1–V4. Shortly thereafter, he became hypotensive and coded. Despite resuscitation he passed away. Autopsy revealed massive pulmonary emboli with near complete obstruction of the involved branches of the pulmonary arteries. Coronary arteries were free of significant coronary artery disease and multiple sections of the myocardium showed the absence of myocardial infarction.