A 64-year-old woman with hypertension and diabetes presented with acute shortness of breath and left-sided chest discomfort. Electrocardiogram (ECG) demonstrated Q waves, coved ST-segment elevations, and T-wave inversions in leads V₁-V₄, suggesting acute anterior ST-elevation myocardial infarction (STEMI). Catheterization revealed nonocclusive coronary artery disease with elevated pulmonary and right heart pressures, confirmed by echocardiography. Ventilation perfusion scan was deemed high probability for pulmonary embolism (PE). Treatment for a submassive PE was initiated and ECG changes resolved by discharge. This case exemplifies similarities in clinical presentation of PE and acute STEMI. The presence of Q waves in anterior leads with coved ST-elevation after PE has not been described previously. We review the differential diagnosis of ST elevation and the assorted spectrum of ECG changes seen in PE.