Asymptomatic Pulmonary Embolus in a Patient With a Prior Heart Transplant

Area of Science:

• Cardiology
• Transplantation Medicine
• Vascular Medicine

Background:

• Heart transplant recipients have an elevated risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE).
• VTE can occur at any point during the post-transplant course, necessitating ongoing surveillance.

Observation:

• A 63-year-old male, nine years post-orthotropic heart transplant, presented with acute right lower extremity pain.
• Imaging revealed extensive DVT in the femoral vein and calf deep veins.
• The patient was asymptomatic for pulmonary embolism despite the significant DVT burden.

Findings:

• The patient was successfully managed with a heparin infusion followed by apixaban, an oral anticoagulant.
• Discharge occurred on hospital day 2 with no immediate complications.

Implications:

• This case underscores the critical need for heightened awareness of VTE risk in heart transplant patients.
• Clinicians should consider VTE in heart transplant recipients presenting with non-specific symptoms, even in the absence of classic PE signs.
• Prompt diagnosis and anticoagulation are crucial for managing VTE in this vulnerable population.