American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2021, 9(5), 272-274
DOI: 10.12691/ajmcr-9-5-2
Open AccessCase Report

New Onset Atrial Fibrillation and Pulmonary Embolism in a Hospitalized Patient: Which Comes First?

Chukwuemeka A. Umeh1, , Ankit Dubey1, Mohammad Yousuf1 and Stella Onyi2

1Department of Internal Medicine, Hemet Valley Medical Center, Hemet, California, USA

2Department of Radiology, Hemet Valley Medical Center, Hemet, California, USA

Pub. Date: February 19, 2021

Cite this paper:
Chukwuemeka A. Umeh, Ankit Dubey, Mohammad Yousuf and Stella Onyi. New Onset Atrial Fibrillation and Pulmonary Embolism in a Hospitalized Patient: Which Comes First?. American Journal of Medical Case Reports. 2021; 9(5):272-274. doi: 10.12691/ajmcr-9-5-2

Abstract

Background: Atrial fibrillation (AF) is associated with increased rates of stroke and other thrombo-embolic events, heart failure, reduced quality of life, reduced exercise capacity, left ventricular (LV) dysfunction and death. Atrial fibrillation can be a risk factor for pulmonary embolism (PE) or a consequence of PE. This case report highlights the complex relationship between AF and PE. Case report: We report a case of a hospitalized 69-year-old male with new onset AF with rapid ventricular response with concurrent newly diagnosed PE. The rate uncontrolled AF in the hospitalized patient triggered the investigation for PE in this patient. Conclusion: For hospitalized patients with new onset AF, PE should be considered and searched for even in patient on prophylactic venous thromboembolism anticoagulation especially if patient is symptomatic (palpitations, shortness of breath, syncope, hypoxia, chest pain) or echocardiogram shows signs of right heart strain.

Keywords:
Atrial fibrillation rapid ventricular response pulmonary embolism case report

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2014 Dec 2; 64(21): e1-76.
 
[2]  Developed with the special contribution of the European Heart Rhythm Association (EHRA), Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), Authors/Task Force Members, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European heart journal. 2010 Oct 1; 31(19): 2369-429.
 
[3]  Gex G, Gerstel E, Righini M, Le Gal G, Aujesky D, ROY PM, Sanchez O, Verschuren F, Rutschmann OT, Perneger T, Perrier A. Is atrial fibrillation associated with pulmonary embolism? Journal of thrombosis and haemostasis. 2012 Mar; 10(3): 347-51.
 
[4]  Lohani S, Tachamo N, Timilsina B, Nazir S. Pulmonary embolism and atrial fibrillation: A complicated relationship. International Journal of Case Reports and Images (IJCRI). 2017 Jun 1; 8(6): 376-9.
 
[5]  Bikdeli B, Jiménez D. Atrial fibrillation in the course of pulmonary embolism: just a little smoke, or fuel to the fire?. Journal of internal medicine. 2020 Jan; 287(1): 114-6.
 
[6]  Ptaszynska-Kopczynska K, Kiluk I, Sobkowicz B. Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis. BioMed research international. 2019; 2019.
 
[7]  Ng AC, Adikari D, Yuan D, Lau JK, Yong AS, Chow V, Kritharides L. The prevalence and incidence of atrial fibrillation in patients with acute pulmonary embolism. PloS one. 2016; 11(3).
 
[8]  Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis III PW. The electrocardiogram in acute pulmonary embolism. Progress in cardiovascular diseases. 1975 Jan 1; 17(4): 247-57.
 
[9]  Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, Weg JG. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991 Sep 1; 100(3): 598-603.
 
[10]  Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, Allescia G, Pistolesi M. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. American journal of respiratory and critical care medicine. 1999 Mar 1; 159(3): 864-71.
 
[11]  Ebner M, Rogge NI, Parwani AS, Sentler C, Lerchbaumer MH, Pieske B, Konstantinides SV, Hasenfuß G, Wachter R, Lankeit M. Atrial fibrillation is frequent but does not affect risk stratification in pulmonary embolism. Journal of internal medicine. 2020 Jan; 287(1): 100-13.