Acute Pulmonary Embolus
A 49 y.o. M with HTN, HL and prior history of treated PE presents with dyspnea on exertion and CT-PA showing acute pulmonary embolus. Oxygen saturation was in the 80s on room air, but patient was normal heart rate and normal blood pressure. What are the next steps in management?
Remember that after the patient’s hemodynamic stability is ensured, the next step is to examine the RV function. This can be done with echocardiography, but also can be assessed by using CT-PA. Echocardiography on presentation shows RV systolic failure and consequently patient had systemic thrombolysis.
Other lab tests that are useful in prognostication of clinical outcomes are Troponin and BNP. Elevation in these tests correlates with increased mortality. Patients with elevated troponin had a 9.4x higher rate of death than those without.
Recent NEJM review article about management of acute pulmonary embolism:
- Acute Pulmonary Embolism – N Engl J Med 2010; 363:266-274
2009 European Society of Cardiology guidelines for acute pulmonary embolism