New Onset Atrial Fibrillation and Pulmonary Embolism in a Hospitalized Patient: Which Comes First?

Background: Atrial fibrillation (AF) is associated with increased rates of stroke and other thrombo-embolic events, heart failure, reduced quality of life, reduced exercise capacity, left ventricular (LV) dysfunction and death. Atrial fibrillation can be a risk factor for pulmonary embolism (PE) or a consequence of PE. This case report highlights the complex relationship between AF and PE. Case report: We report a case of a hospitalized 69-year-old male with new onset AF with rapid ventricular response with concurrent newly diagnosed PE. The rate uncontrolled AF in the hospitalized patient triggered the investigation for PE in this patient. Conclusion: For hospitalized patients with new onset AF, PE should be considered and searched for even in patient on prophylactic venous thromboembolism anticoagulation especially if patient is symptomatic (palpitations, shortness of breath, syncope, hypoxia, chest pain) or echocardiogram shows signs of right heart strain.