A unique case of pulmonary embolism presenting as a paroxysmal atrial tachycardia instigated only by recumbency and stooping

Atrial tachyarrhythmias occur in 4%–14% of patients presenting with pulmonary embolism (PE), sinus tachycardia being the most common, followed by atrial tachycardia (AT), atrial fibrillation, and atrial flutter, in that order. Although AT has been described with PE, its exclusive occurrence with changes in body posture after PE has not been previously reported. In fact, atrial arrhythmia occurring de novo with changes of posture in itself is a rare phenomenon, except perhaps in the setting of positional irritation from a venous catheter in the right atrium or possibly sympathetic surge from baroreceptor reflex. Here we describe an unusual case of paroxysmal AT occurring only when lying down or bending, in an otherwise healthy female subject presenting with an acute PE.