# Beyond Traditional Risk Factors: Cocaine Abuse and Pulmonary Embolism

## TL;DR

This paper presents a case where cocaine abuse led to a severe pulmonary embolism requiring emergency treatment.

## Contribution

The case highlights cocaine abuse as a contributing factor to massive pulmonary embolism in a young male.

## Key findings

- The patient presented with syncope, right heart strain, and elevated cardiac biomarkers due to a massive PE.
- Mechanical thrombectomy significantly reduced clot burden and improved pulmonary artery perfusion.
- Cocaine abuse was identified as a potential risk factor for the acute bilateral pulmonary emboli.

## Abstract

Pulmonary embolism (PE) is a critical and potentially life-threatening condition necessitating prompt diagnosis and intervention due to its significant risk of morbidity and mortality. We present a case of a 42-year-old male with a history of cocaine abuse who was admitted with a massive PE (high risk), defined by hemodynamic instability or evidence of significant right ventricular dysfunction. In this case, the severity was suggested by syncope, right heart strain, and elevated cardiac biomarkers. The patient reported sudden onset shortness of breath, sharp chest pain exacerbated by inspiration, and a syncopal episode. Clinical evaluation revealed tachycardia and hypoxemia. Diagnostic tests showed elevated D-dimer levels and signs of right ventricular strain on echocardiography. Computed tomography pulmonary angiography (CTPA) confirmed acute bilateral pulmonary emboli, with a large clot burden predominantly in the right pulmonary artery. The patient underwent a mechanical thrombectomy, which significantly reduced the clot burden and improved pulmonary artery perfusion.