A 53-Year-Old With Progressive Dyspnea.

Area of Science:

• Cardiology
• Pulmonology
• Emergency Medicine

Background:

• A 53-year-old female with a history of pulmonary embolism treated with rivaroxaban presented to the Emergency Department (ED).
• The patient reported four days of acutely worsening dyspnea and chest pressure.

Observation:

• Vital signs on arrival: Temperature 36.7 °C, Heart Rate 71 bpm, BP 98/59 mmHg, Respiratory Rate 22 breaths/min, SpO2 95% on room air.
• Laboratory findings revealed an elevated White Blood Cell (WBC) count of 15,770/μL.
• Elevated International Normalized Ratio (INR) of 1.66 and elevated partial thromboplastin time (PTT) of 18.8 s were noted.
• Pro-brain natriuretic peptide (pro-BNP) was slightly elevated at 530 pg/mL (normal < 300 pg/mL).

Findings:

• The clinical presentation and laboratory results suggest a potential exacerbation or complication in a patient with a known history of pulmonary embolism.
• Elevated WBC and pro-BNP warrant further investigation for underlying causes such as infection or cardiac strain.
• The slightly elevated INR and PTT in the context of rivaroxaban treatment require careful interpretation regarding anticoagulation status and potential bleeding risk.

Implications:

• This case underscores the importance of a comprehensive diagnostic approach in patients presenting with acute cardiopulmonary symptoms, especially those with a history of venous thromboembolism.
• Prompt evaluation is crucial to differentiate between pulmonary embolism recurrence, alternative diagnoses, or complications of anticoagulation therapy.
• Accurate assessment of coagulation parameters and cardiac biomarkers is essential for guiding timely and appropriate management decisions.