Submassive Pulmonary Embolism a A Watch-and-Wait Strategy with Anticoagulation Alone or Advanced Therapy with Thrombolysis
A 65-year old man, presented with syncope and dyspnea. On examination he was tachypneic, hypoxemic, normotensive, with elevated D-dimer and cardiac troponin. ECG showed sinus tachycardia S1Q3T3 syndrome and echocardiography revealed right ventricular dysfunction. Urgent computed tomograph angiograms showed bilateral pulmonary embolism. After treatment with intravenous tpA the patient’s status improved and echocardiogram showed decreasing of the right ventricular systolic pressure. The most widely accepted indication for thrombolic therapy is proven pulmonary embolism with cardiogenic shock; therapy is also frequently considered when a patient presents with systemic hypotension without shock. The use of thrombolysis in submassive embolism – that is pulmonary embolism causing right ventricular (RV) dilatation and hypokinesis with systemic hypotension – is debated.1 The purpose of the study was to demonstrate a case of submassive pulmonary embolism who had an excellent clinical electrocardiographic and echocardiographic response to fibrinolysis.
