A 60-Year-Old Smoker With HTN Presents to the ER With Shortness of Breath

A 60-year-old woman with a history of hypertension and tobacco use presents to the emergency room with complaints of shortness of breath for the last two hours. She has no history of heart disease and denies any recent chest pain. On arrival to the emergency room, her vital signs and pertinent physical exam are noted to be:

Respiratory Rate: 18 breaths per minute
Heart rate: 98 beats per minute
Blood pressure: 115/60 mmHg
O2 sat: 88% on room air

Physical exam:
General: Appears well, in no acute distress
CV: Regular rate and rhythm, Normally split S1, S2, No murmur or S3. JVP normal. Normal peripheral pulses. No carotid or abdominal bruits.
Pulmonary: Mildly labored breathing. Breath sounds throughout. No wheezes, rales or rhonchi.

Labs on arrival:
Hgb: 13.8gm/dL
Platelets: 180,000
D-dimer: 1.4 ug/mL (upper limit cutoff 0.5 ug/mL)
BUN/Cr: 18/0.79 mg/dL
Troponin T: 0.24 ng/mL (upper limit cutoff 0.11 ng/mL)
BNP: 210 pg/mL (upper limit cutoff 100 pg/mL)

EKG: Sinus rhythm, normal axis, no acute ST changes
Chest X-ray: no acute cardiopulmonary process.

CT pulmonary angiogram: Multiple scattered thrombi seen in the intermediate pulmonary arteries. No thrombus is seen in the main pulmonary arteries or right and left trunk. RV dimension appears larger in size compared to left.

She is started on a heparin drip, and you are contacted to further address the significance of the elevated troponin and BNP.

How would you advise the primary team?

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