From Loyola University Medical Center, Maywood, Illinois. For current author addresses, see end of text .
Paradoxical embolism is a rare cause of myocardial infarction.
We describe a patient in whom morbid obesity obscured clinical examination and rendered invasive diagnostic evaluation by angiography unfeasible. These possibilities included left ventricular systolic dysfunction, pulmonary embolism, pulmonary sepsis, and acute decompensation of chronic pulmonary disease caused by morbid obesity. Three weeks before admission, he had lost consciousness briefly and had had associated numbness in both hands and chest pain radiating to the left shoulder. The chest pain had resolved rapidly but had recurred intermittently over the following 3 days. Breath sounds were diffusely diminished, and rales were heard bilaterally throughout the lower third of the thorax.