# A Silent Saddle Embolism: Syncope Without Dyspnea or Chest Pain

## TL;DR

A rare case of pulmonary embolism causing fainting without typical symptoms is described, highlighting the need for early imaging.

## Contribution

Presents a rare case of submassive saddle PE manifesting only as syncope, emphasizing early diagnostic approaches.

## Key findings

- A patient with syncope was diagnosed with a large saddle PE without dyspnea or chest pain.
- Right ventricular dysfunction and elevated troponin indicated myocardial injury from the embolism.
- Catheter-directed thrombectomy and anticoagulation successfully treated the PE.

## Abstract

Pulmonary embolism (PE) is a potentially fatal diagnosis that may present without classic symptoms. We describe a rare presentation of a submassive saddle PE manifesting solely as syncope, without dyspnea or chest pain. The patient was found to have significant right ventricular dysfunction and myocardial injury with elevated troponin and was ultimately diagnosed with a large saddle PE and successfully treated with catheter-directed thrombectomy and anticoagulation. This case underscores the importance of echocardiographic RV assessment and early imaging in syncope workup to avoid delayed or missed PE diagnoses.