Submassive Pulmonary Embolism – A ‘Watch-And-Wait’ Strategy with Anticoagulation Alone or Advanced Therapy with Thrombolysis

Daniel Bogdanov Petrov^1, , Svetlozar Ivanov Sardovski¹, Emilian Iliev Gagov¹ and Maria Hristova Milanova¹

¹Department of Cardiology, “Pirogov” Emergency Hospital, Sofia, Bulgaria

Cite this paper:
Daniel Bogdanov Petrov, Svetlozar Ivanov Sardovski, Emilian Iliev Gagov and Maria Hristova Milanova. Submassive Pulmonary Embolism – A ‘Watch-And-Wait’ Strategy with Anticoagulation Alone or Advanced Therapy with Thrombolysis. American Journal of Medicine Studies. 2013; 1(3):19-21. doi: 10.12691/ajms-1-3-2

Abstract

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 . 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.

Keywords:
submassive pulmonary embolism thrombolysis advanced therapy

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