Year: 2024
Type: article
Study design: Case Report
Abstract: TUTORIALshowed paradoxical motion of the interventricular septum (IVS), elevated pulmonary artery systolic pressure (50 mm Hg), mild right atrial/right ventricular (RA/RV) dilatation, and normal left ventricular (LV) systolic function.Chest X-ray revealed left middle zone haziness/consolidation (Fig. 1).Lower limb Doppler study on both sides was normal.Ultrasound of the abdomen was suggestive of grade I fatty changes in the liver.The patient was initially managed with potassium correction, one unit blood transfusion, parenteral iron, intravenous frusemide, airwaynebulization, and supportive care.Additionally, she received oseltamivir and azithromycin considering community-acquired pneumonia.Computed tomography of pulmonary angiogram (CTPA) showed dilatation of the main pulmonary artery trunk, filling defects in the left main pulmonary artery causing near complete occlusion, suggestive of acute thrombus (Fig. 2).Risk factors such as bedridden status, trauma, thrombophilia, local infection, venous compression, intravenous catheters, cancer, oral contraceptives, and pregnancy was ruled out.The thrombotic workup namely antithrombin-III assay, homocysteine, protein-C, IntroductIonPulmonary thromboembolism (PTE) is a life-threatening condition.Since the presentation of PTE is nonspecific, the diagnosis is a major challenge.Pregabalin-associated cardiovascular side effect such as pulmonary embolism (PE) is possible but a rare phenomenon. 1 The breathing issues associated with pregabalin (increased pauses in breathing during sleep) have been warned by the United States Food and Drug Administration in the year 2019. 2 This writeup reports pregabalin-associated PTE due to long-term pregabalin treatment for diabetic neuropathy.The clinician should have a high degree of suspicion about PE in patients who present to the hospital for breathlessness and on long-term pregabalin treatment. case descrIptIonThis is a case of 47-year-old female who presented to a tertiary care center with a history of shortness of breath for 4 days.Breathlessness was sudden in onset and associated with on/off chest pain and dry cough.She also complained of intermittent pain in both lower limbs.She was a known case of diabetes mellitus (oral metformin 250 mg once daily) and hypertensive (oral metoprolol 50 mg once daily).She was also on tablet pregabalin 75 mg once daily for diabetic neuropathy for 5 years.Initially evaluated in the emergency department (ED), she was afebrile with a heart rate of 112 beats/minute, blood pressure of 102/52 mm Hg, respiratory rate of 28/minute, and a peripheral oxygenation saturation of 88% breathing room air.Routine blood investigations showed hypokalemia with potassium 3.0 mEq/L, hyponatremia with sodium 126 mEq/L, serum creatinine 0.4 mg/dL, hemoglobin 8.7 gm/dL, total leukocyte count of 18,000, prothrombin time of 13.1 seconds, international normalized ratio (INR) of 0.9, Activated partial thromboplastin time (APTT): 25.3, troponin test < 40, NT-Pro brain natriuretic peptide (BNP) of 1774, and D-dimer of 2.29 mg/L.An electrocardiogram (ECG) showed T-wave inversion in lead III.
Source: Journal of Acute Care
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4396518715