rivaroxaban and Dyspnea

An 84-year-old woman presented to the interventional pulmonary clinic for evaluation of a right middle lobe lung mass. Her medical history was notable for atrial fibrillation on rivaroxaban and recurrent bilateral breast cancer that had required multiple lumpectomies, radiation, and chemotherapy. She is a former smoker of five-pack years. She underwent a right and left heart catheterization at an outside facility 2 months prior to her presentation for evaluation of dyspnea that showed minimal coronary artery disease but elevated pulmonary artery pressures of 55/24 mm Hg. The procedure itself was complicated by hemoptysis that required hospital admission for observation. She underwent a chest radiography during her hospitalization (Fig 1) There was no recent imaging for comparison. She was seen by a pulmonologist as an outpatient and underwent bronchoscopy with BAL and bronchial brushing for concerns of malignancy. The results were not diagnostic. She was then referred to the interventional pulmonary service for further evaluation.

Topics: Aged, 80 and over; Dyspnea; Female; Hemoptysis; Humans; Lung; Radiography; Rivaroxaban

Topics: Dyspnea; Female; Humans; Leukocyte Count; Middle Aged; Pulmonary Embolism; Rivaroxaban

Topics: Anticoagulants; Arm; Dyspnea; Edema; Factor Xa Inhibitors; Humans; Pulmonary Embolism; Rivaroxaban; Treatment Outcome

BACKGROUND Several studies have described an increased incidence of venous thromboembolism in inflammatory conditions such as sarcoidosis. CASE REPORT We report a case of a 27-year-old African-American man who developed sarcoidosis with pulmonary involvement after 4 years of unexplained thromboembolism. CONCLUSIONS This report discusses the relationship between sarcoidosis and venous thromboembolism. Our case raises questions about this relationship. Can sarcoidosis lead to an inflammatory and prothrombotic state prior to the development of other manifestations?

Topics: Adult; Anti-Inflammatory Agents; Cough; Diagnosis, Differential; Dyspnea; Factor Xa Inhibitors; Humans; Male; Prednisone; Rivaroxaban; Sarcoidosis; Tomography Scanners, X-Ray Computed; Venous Thromboembolism

BACKGROUND Renal vein thrombosis is uncommon and can be associated with nephrotic syndrome. It is associated with high patient morbidity , and it may lead to thromboembolic event. CASE REPORT A 44-year-old woman presented with shortness of breath, chest pain and tightness, due to bilateral pulmonary embolism originating from right renal vein thrombosis. The diagnosis was made by transthoracic echocardiography and enhanced computed tomography (CT) scan of chest, abdomen, and pelvis. No underlying diseases were found. She was treated with heparin infusion therapy and rivaroxaban with good clinical outcome. CONCLUSIONS A rare case is presented of isolated unilateral right renal vein thrombosis diagnosed following bilateral pulmonary embolism in a previously healthy 44-year-old woman, which was successfully treated with the DOAC, rivaroxaban.

Topics: Adult; Anticoagulants; Chest Pain; Dyspnea; Female; Humans; Pulmonary Embolism; Renal Veins; Rivaroxaban; Tomography, X-Ray Computed; Venous Thrombosis

Stroke is a recognized clinical course of hypertrophic cardiomyopathy. This interesting case showed notable difference on the electrocardiogram of a patient 4 months prior to suffering a stroke and 10 days after suffering a stroke. The pre-stroke electrocardiogram showed atrial fibrillation with a narrow QRS complex, while the post-stroke electrocardiogram showed marked left ventricular hypertrophy. Left ventricular hypertrophy was diagnosed using the Sokolow-Lyon indices. The development of left ventricular hypertrophy a few days after suffering a stroke has not previously been reported.. An 83-year-old white British woman with a background history of permanent atrial fibrillation, hypertension, and previous stroke attended the emergency department with a 2-day history of exertional dyspnea, and chest tightness. On examination, she had bibasal crepitations with a systolic murmur loudest at the apex. In-patient investigations include an electrocardiogram, blood tests, chest X-ray, contrast echocardiogram, coronary angiogram, and cardiovascular magnetic resonance imaging. An electrocardiogram showed atrial fibrillation, with inferolateral T wave inversion, and left ventricular hypertrophy. A chest X-ray showed features consistent with pulmonary edema. A contrast echocardiogram showed marked hypertrophy of the mid to apical left ventricle, appearance consistent with apical hypertrophic cardiomyopathy. Coronary angiography showed eccentric shelf-type plaque with non-flow-limiting stenosis in the left coronary artery main stem. Cardiovascular magnetic resonance imaging reported findings highly suggestive of apical hypertrophic cardiomyopathy. Our patient was treated and discharged on rivaroxaban, bisoprolol, and atorvastatin with a follow-up in the cardiomyopathy outpatient clinic.. Electrocardiogram diagnosis of left ventricular hypertrophy led to the diagnosis of apical hypertrophic cardiomyopathy in this patient. Left ventricular hypertrophy was only evident a few days after our patient suffered a stroke. The underlying mechanisms responsible for this remain unclear. Furthermore, differential diagnosis of hypertrophic cardiomyopathy should be considered in people with electrocardiogram criteria for left ventricular hypertrophy. Cardiovascular magnetic resonance imaging is an important diagnostic tool in identifying causes of left ventricular hypertrophy. Family screening should be recommended in patients with new diagnosis of hypertrophic cardiomyopathy.

Topics: Aged, 80 and over; Antihypertensive Agents; Bisoprolol; Cardiomyopathy, Hypertrophic; Chest Pain; Coronary Angiography; Diagnosis, Differential; Dyspnea; Electrocardiography; Factor Xa Inhibitors; Female; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging; Rivaroxaban; Stroke; Treatment Outcome

A 77-year-old woman presented to the hospital with symptoms of progressive shortness of breath with associated right-sided pleuritic pain. The patient had begun noting dyspnea on exertion, limiting her ability to go on hikes over the few days prior to admission. Her medical history is significant for carcinoid tumor status postresection in 2012 without recurrence. She has no history of thromboembolism or clotting disorders, and she has no history of smoking or drug abuse. Current medications include amlodipine, celecoxib, hydrochlorothiazide, and rosuvastatin.

Topics: Acute Disease; Aged; Chest Pain; Dyspnea; Echocardiography; Factor Xa Inhibitors; Female; Humans; Pulmonary Veno-Occlusive Disease; Rivaroxaban; Tomography, X-Ray Computed; Venous Thrombosis

Topics: Adult; Antihypertensive Agents; Aspirin; Chest Pain; Coronary Vasospasm; Dyspnea; Humans; Lisinopril; Male; Marijuana Smoking; Metoprolol; Muscle Tonus; Rivaroxaban; Tobacco Smoking; Treatment Outcome; Young Adult

Imaging work-up of a 80-year-old woman with sudden onset of dyspnea during current rivaroxaban therapy: computer tomography angiography revealed fulminant bilateral pulmonary embolism. Furthermore, a serpentine-like huge mass in the right atrium was detected, highly suggestive of thrombus or a giant chiari network, respectively. This case highlights the importance of adequate dose regimen of factor Xa inhibitors, as well as the need of thorough differential diagnostic considerations of net like structures in the right atrium.

Topics: Aged, 80 and over; Atrial Fibrillation; Computed Tomography Angiography; Drug Dosage Calculations; Drug Substitution; Dyspnea; Factor Xa Inhibitors; Female; Heart Diseases; Heparin; Humans; Pulmonary Embolism; Pyrazoles; Pyridones; Rivaroxaban; Thrombosis; Treatment Outcome

Pulmonary embolism remains one of the leading causes of cardiovascular mortality. The standard treatment for pulmonary embolism is anticoagulant therapy using low molecular weight heparin, fondaparinux and a vitamin K antagonist, but a recent clinical trial showed that rivaroxaban, an oral factor Xa inhibitor, was as effective as standard therapy for the initial and long-term treatment of pulmonary embolism and had less bleeding complications.. The present report describes the case of an 80-year-old white man with an intermediate to low early mortality risk of pulmonary embolism. He was successfully treated with rivaroxaban (administered orally as monotherapy), demonstrating rapid benefit without any adverse events.. Rivaroxaban, particularly in the acute phase of pulmonary embolism, may be considered an effective and safe therapeutic choice even in elderly patients, a population less represented in clinical trials.

Topics: Administration, Oral; Aged, 80 and over; Anticoagulants; Dyspnea; Humans; Male; Pulmonary Embolism; Risk Assessment; Rivaroxaban; Treatment Outcome

Topics: Aged, 80 and over; Diagnosis, Differential; Dyspnea; Factor Xa Inhibitors; Female; Heart Failure; Humans; Hyponatremia; Rivaroxaban