Very interesting case and well written.
One could postulate that the hypoxia associated with massive PE might have caused ischaemic changes without infarction or that the death was too soon for changes of infarction to be visible at post mortem examination.
Either way, a good learning point, though clearly thrombolysis for either PE or MI would not have been feasible due to the recent GI bleed and therefore the outcome was inevitable.

Reviewer
Dr Noeleen Foley
Royal United Hospital

Variable ECG findings associated with pulmonary embolism