Fortunate or Unfortunate Patient? A Complex Case of Unstable Angina, Pulmonary Embolism, and Procoagulatory State Caused by Colon Cancer

Introduction Unstable angina (UA) is myocardial ischaemia at rest or on minimal exertion without acute cardiomyocyte necrosis [1]. It has complex lesions and rapid progress, which is why it requires immediate management. [2] Although the patient presents with the following diagnosis, sometimes it can be the last condition cured in the iceberg of health problems. Case Presentation A 77-year-old patient was admitted for unstable angina, displaying symptoms such as worsening chest pain, dyspnea during exercise, and right foot pain. He had a history of arterial hypertension, heart failure, dyslipidemia, permanent atrial fibrillation, and colon carcinoma. Medical therapy included: Atorvastatin 60mg x 1, Spironolactone 25mg x1, Apixaban 2,5mg x2. The assessment began with an ECG and transthoracic echocardiogram, which revealed right-side overload and an increase in D-dimers and dyspnea, which suggested pulmonary embolism. A chest CTA was performed, that stated acute PE with right heart overload. Enoxaparin 0.7 ml x 2 was initiated. A few days later, an ultrasound and CTA of both legs showed occlusion in a. poplitea dex. The patient’s right lower leg was subsequently amputated. Day after, results of a CT scan of the chest, abdomen, and pelvis revealed intramural thrombi in a. mesenterica sup. and a colon lesion, which was confirmed by biopsy to be adenocarcinoma G1-2. The following week, abdominal visceral angiography and PTA resulted in better a.colica dex. and a.ileocolica perfusion. Finally, coronary angiography revealed critical stenosis in the left main trunk and proximal LAD, where PTCAA and stents were placed. Aspirin 100 mg x1 and clopidogrel 75 mg x1 were administered. The patient made a full recovery. Discussion This case highlights the relationship between cardiovascular disease, thromboembolic events, and malignancy. Here it was difficult to make a prognosis. Early diagnosis, rapid interventional treatment, and multidisciplinary team collaboration were the key factors in maximizing the prognosis of such patients. Conclusions In conclusion, a systemic approach to diagnosing and treating patients with multiple comorbidities should be encouraged. In this case, the complexities of managing an elderly patient with unstable angina were handled correctly, which is why the patient had a favourable prognosis and full recovery.