Figure 1: Electrocardiogram (ECG) showing sinus arrhythmia,
borderline T abnormalities, diffuse leads, no ST elevations, and ectopy
Hematology services were consulted. According to them, the patient had a
clotting tendency with acute pulmonary embolism, most likely related to
severe IDA due to heavy menstrual bleeding. Antiphospholipid syndrome
was considered a differential diagnosis. Rheumatoid factor, ANA
(antinuclear antibody) screen, double-strand DNA antibody, and
anti-cardiolipin IgG antibody were within the normal range, which
excluded antiphospholipid syndrome. As per the cardiology team, chest
pain was likely from acute PE. A transthoracic echocardiogram (TTE) was
ordered, which showed an ejection fraction of 55%, mild mitral
regurgitation, and moderate to severe tricuspid regurgitation.
The patient was given a heparin drip, intravenous (IV) hydromorphone
HCl, PO hydrocodone, intravenous (IV) ferric sodium gluconate complex,
and intravenous (IV) methylprednisolone throughout the hospital course.
The patient was discharged on the 3rd day with PO rivaroxaban, as-needed
pain medication, and was advised to follow up with hematology.