[Chest pain and electrocardiogram abnormalities: consider pulmonary embolism]

Pulmonary embolism is a serious and potentially life-threatening disease that requires early recognition and treatment. In three patients, two men aged 60 and 61 and a woman aged 76, prominent severe chest pain and electrocardiographic changes suggesting ischaemic heart disease, lack of response to treatment, marked dyspnoea and haemodynamic instability eventually led to the clinical suspicion and subsequent diagnosis of pulmonary embolism. Electrocardiographic changes are indicative of right-sided overload and sometimes of arterial hypoxaemia. Although ECG changes are very frequent in cases of pulmonary embolism, the abnormalities observed are mostly nonspecific ST-T segment changes.