Venous thromboembolism – multifactorial disease. Case report of a 36-year-old woman

Venous thromboembolism (VTE) is a condition that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). Venous thromboembolism is the third most common cardiovascular disease, after myocardial infarction and stroke, among the general population. The overall annual incidence of VTE is estimated to be 1–2 per 1000 adults per year. Venous thromboembolism is a multifactorial disease with both inherited and acquired risk factors. In 26–47% of first-time VTE cases the aetiology is unknown [1]. The main symptoms reported by patients are dyspnoea, chest pain and cough, unilateral extremity swelling, and unilateral leg pain. In most patients, deterioration of health withdraws after treatment and never returns, but in some people recurrence of VTE is reported [2]. We present the case report of a 36-year-old female with venous thromboembolism.
We describe the case report of a 36-year-old woman with venous thromboembolism, in whom initial presentation was pain and tenderness of right lower limb, syncope, and breathlessness. An abnormal condition was preceded by 9 h of immobilisation due to sitting in a car. The 36-year-old woman had been diagnosed with polycystic ovary syndrome (PCOS) a few years previously, so she was currently treated with monophasic combined oral contraceptive (COC) (drospirenone (3 mg) with ethinyl oestradiol (30 µg) for 4 years (long-term treatment)). The patient had no history of smoking or alcohol abuse and no family history of cardiovascular diseases. The ECG demonstrated sinus tachycardia and an SI, QIII, TIII pattern (Figure 1) suggestive of pulmonary embolisation, and anterior and inferior wall ischaemic myocardium. Physical examination revealed normal blood pressure (BP – 120/80 mm Hg), tachycardia (105 bpm), tachypnoea (rate 26), tenderness of right lower limb, and overweight (BMI = 28.9 kg/m²); otherwise, there were no deviations from the norm in physical examination. Arterial blood gas (ABG) analysis was done on admission, which identified reduced oxygen partial pressure (pO2 = 64 mm Hg), lowered partial pressure of carbon dioxide (pCO2 = 30 mm Hg), and reduced arterial oxyhaemoglobin saturation (SaO2 = 94%). Other laboratory examinations showed normal morphology and inflammatory parameters, and elevated values of troponin T (83.8 ng/l), D-dimer (7796 µg/l), and B-type natriuretic peptide (BNP = 399 pg/ml). Our patient excluded the possibility of pregnancy and this was confirmed in a quantitative...


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