Syncope as the initial presentation of pulmonary embolism in a patient with asymptomatic COVID-19: a case report

ABSTRACT

Syncope is a common clinical presentation, often may remain unexplained. PE is thought to be an uncommon cause of syncope. Hormone therapy (HT) is a known risk factor for thromboembolic disease (TD). The new coronavirus SARS-CoV-2 (COVID-19)pandemic has emerged in China and spread around the world. A higher prevalence of PE has been described in critically ventilated patients with COVID-19 but few data exist on the prevalence of TD in asymptomatic patients. We present a case of insidious development of PE probably promoted by the COVID19 infection. A previously healthy 51 year old female, obese (BMI 34 kg/m2), was admitted to the emergency department for syncope (third generation assays negative for Covid19). She reported HT for 4 months. She was tachypnoic (22 breaths/min), peripheral oxygen (SpO2) was 94% (room air). EKG sinus tachycardia (137 beats/min) with S1Q3T3 aspect;arterial blood gases moderate hypoxemia (PaO2 61.2 mmHg). ETT dilated and hypocontractile right ventricle, D-shape aspect of the IVS, dilated inferior vena cava (23 mm), estimated PAP65 mmHg. We administered parenteral anticoagulant therapy and O2 therapy. We suspected PE, which was confirmed by contrast chest CT;no lung parenchymal involvement was documented.Later, we found RT-PCR assays positive for Covid19. PE should be suspected in all patients with syncope. The prevalence of TD in Covid19 asymptomatic patients is partially studied. Although current guidelines do not recommend the use of thromboprophylaxis in outpatient COVID-19, we believe that each case must be evaluated individually. More studies are needed to evaluate the risk-benefit ratio.