BACKGROUND: Coronary heart disease (CHD) and pulmonary embolism (PE) are thrombotic diseases. Patients with CHD and PE are common in clinical practice. However, the clinical diagnosis of PE is challenging due to overlapping primary symptoms, such as chest tightness and dyspnea. This confluence frequently leads to the misdiagnosis of PE, thus precipitating treatment delays and compromising patient outcomes. Herein, we report the case of a patient with both diseases who underwent surgery and medication therapy. CASE SUMMARY: A 51-year-old man with a history of hypertension for 2 years visited a local hospital because of paroxysmal chest tightness for 1 d and was diagnosed with CHD. However, he refused hospitalization. He visited our hospital for the treatment of recurring symptoms. A comprehensive examination after admission revealed elevated D-dimer levels, and computed tomography pulmonary angiography was performed to confirm the diagnosis of PE. The patient successfully underwent coronary artery bypass grafting with anticoagulant and antiplatelet drugs and had a prognosis. CONCLUSION: D-dimer is useful in screening for PE, whereas computed tomography pulmonary angiography is important for diagnosis. For patients with CHD and PE, coronary artery bypass grafting combined with anticoagulant and antiplatelet therapy is feasible.