A 50-year-old obese male with a history of deep vein thrombosis presents with sudden onset dyspnea and palpitations. On physical exam, you notice leg swelling. His ECG shows sinus tachycardia. What is the most likely diagnosis, and what are the next steps?
This patient's history of deep vein thrombosis (DVT), obesity, sudden onset of dyspnea and palpitations, leg swelling, and sinus tachycardia on ECG are all indicative of a likely pulmonary embolism. The next steps should include immediate anticoagulation, provided there are no contraindications, and confirmatory testing with a CT pulmonary angiography. If there is a high risk of kidney injury from the contrast material used in the CT scan, a ventilation-perfusion (V/Q) scan can be considered.