Case Report
Mitevska I
Abstract
A 42-year-old, previously healthy woman, admitted to our emergency department with first episode of severedyspnea and chest pain, hemodynamically stable. She has no history of previous cardiovascular or respiratorydisease, no history of PE or DVT. She had elevated D-dimers. Urgent echocardiography showed indirect signs ofPE, which was confirmed by pulmonary artery CT angiography, which showed massive PE. After two days of heparininfusion she developed hemodynamic instability with cardiogenic shock, treated successfully with fibrinolysis. Thethrombophilia profile was done two weeks after stopping therapy with rivaroxaban after six months. Thrombophiliapanel came back positive for high levels of homocysteine (67 μmol/L), with other thrombophilia results within normallimits. Pulmonary embolism should be always suspected in younger patients with acute severe dyspnea event withoutprovocable risk factors. High suspicion level and fast diagnosis are lifesaving. In younger patients presenting withunprovoked pulmonary emboli, clinicians should consider inherited prothrombotic factors and homocystinemia as apotential cause. Longer anticoagulation therapy should be considered in these cases with novel oral anticoagulantsas recommended safer and superior therapy.