Pulmonary Thromboembolism Presenting with Recurrent Bradycardia and Hypotension

Recurrent short episodes of bradycardia and hypotension are rarely reported as clinical manifestations of pulmonary thromboembolism (PTE). We report a case of acute massive PTE presenting with dyspnea, burning chest pain with physical activity, and recurrent transient bradycardia and hypotension at rest. Echocardiography showed a left ventricular ejection fraction of 45% with global hypokinesia. Computed tomography angiography showed a large pulmonary thromboembolism. Lytic therapy improved the right ventricular function, and the pulmonary artery pressure decreased to 38 mmHg. Recurrent bradycardia and transient hypotension at rest with syncope on activity and recovery without treatment are not common and may suggest a vasovagal mechanism. Evaluation of patients with these clinical findings could enable early diagnosis and treatment of acute PTE, with decreased morbidity and mortality.