Abstract 17616: The Association Between Hypokinetic Left Ventricle And Pulmonary Embolism

Case Description: A 49-year-old male patient working as a public transport driver presented with syncope lasting a few minutes, followed by non-exertional substernal discomfort. He was hemodynamically stable with a normal physical examination. Laboratory tests revealed an elevated D-dimer of 1146 mg/L and troponin peaking at 1.38 ng/mL. CT Pulmonary angiography was performed, revealing a saddle embolus with signs of right heart strain (Figure 1). A transthoracic echocardiogram revealed a left ventricular (LV) ejection fraction (EF) of 31-35%, and moderately decreased left ventricular systolic function. A venous duplex and hypercoagulability workup yielded negative results. Left-heart catheterization showed normal coronary arteries. A repeat transthoracic echocardiogram three days later showed improvement in LV systolic function with an EF of 41-45% and normal LV function. He was discharged on apixaban with appropriate follow-up. Discussion: Saddle embolism is one of the rare but life-threatening forms of pulmonary embolism. It causes RV dilatation and flattening of the interventricular septum towards the left side, decreasing cardiac output via the “Reverse Bernheim Effect". Rarely, it affects LV contractility and LV ejection fraction. Together, this can lead to severe hemodynamic instability and increase the risk of complications like pulmonary infarction, cardiac arrhythmias, and cardiogenic shock. Therefore, clinicians must be aware of this possibility, as early detection and timely treatment improve patient outcomes.