Asymptomatic Pulmonary Embolus in a Patient With a Prior Heart Transplant

Heart transplant patients have a significant risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE). This report presents a case of asymptomatic PE in a 63-year-old male patient with a history of orthotropic heart transplant nine years prior. The patient initially presented to the Emergency Department with acute right lower extremity pain and was found to have an extensive DVT involving the femoral vein and extending into the deep veins of the right calf. The patient was admitted to the transplant cardiology inpatient service, managed with a heparin infusion, and eventually transitioned to a direct oral anticoagulant with apixaban and discharged on hospital day 2 without further complications. This case highlights the importance of recognizing the heightened risk of venous thromboembolism in heart transplant patients at any point in their post-transplant course, despite the lack of classic symptoms of PE.