Exploration of Cardiology

Table 1. Timeline.

Hospitalization order	Day	Events
First hospitalization	Day 1	Presented with shortness of breath, palpitations, and syncope. CTA showed a large saddle PE with right heart strain. Started on heparin infusion.
	Day 2	Underwent catheter-directed thrombolysis (EKOS). Symptoms and tachycardia improved. Transitioned to apixaban.
	Day 4	Echo showed improving RV function and continued physical therapy.
	Day 5	Discharged on apixaban (3 months) and home oxygen (2 L/min).
Second hospitalization	Day 1	Readmitted the very next day with recurrent syncope. CTA showed a persistent clot burden with right heart strain. Restarted on heparin.
	Day 2	Echo showed McConnell’s sign. Underwent INARI thrombectomy. Transferred to ICU.
	Day 3	Marked improvement; tachycardia and dyspnea resolved.
	Day 4	Stable; cardiology signed off.
	Day 5	Discharged on apixaban and scheduled for outpatient follow-up.

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CTA: computed tomography angiography; EKOS: EkoSonic Endovascular System; PE: pulmonary embolism; RV: right ventricular; ICU: intensive care unit.

Declarations

Author contributions

AJ: Conceptualization, Writing—original draft, Writing—review & editing. FR: Writing—original draft, Writing—review & editing. AI: Writing—review & editing. EM: Writing—review & editing. AM: Writing—original draft, Writing—review & editing. AR: Writing—review & editing. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was conducted in accordance with institutional guidelines and the principles of the Declaration of Helsinki. The institutional ethics committee of Baptist Memorial Hospital confirmed that formal approval was not required for this retrospective case report.

Consent to participate

Informed consent to participate in the study was obtained from the patient.

Consent to publication

Informed consent for publication was obtained from the patient.

Availability of data and materials

The data supporting this manuscript are available from the corresponding author upon reasonable request (frajab258@gmail.com).

Funding

Not applicable.

Copyright

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Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

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