Why do pulmonary emboli cause haemodynamic instability?

PE can lead to right ventricular (RV) failure due to acute pressure overload: Pulmonary artery pressure (PAP) increases in the presence of obstruction Becomes evident if >30-50% of the total cross-sectional occluded by thromboemboli Obstruction due to: Mechanical...

What are the echocardiographic findings seen in PE?

Dilatation of the right ventricle Impaired right ventricular function  Flattened intraventricular septum Distended inferior vena cava with diminished inspiratory collapsibility  Tricuspid regurgitation Mobile thrombus in the right heart Dilatation of the right...

What are the indications for thrombolysis in PE?

High-risk (massive) PE Selected cases of intermediate-risk (sub-massive) PE: Currently not routinely recommended by ESC guidance Some evidence it improves long term outcomes ESC Guidelines...

What is the role for thrombolysis in sub-massive PE?

Some argue in favour of thrombolysis given improved longer-term outcomes: Reduced burden of chronic RV failure or thrombus-related pulmonary hypertension Others argue against thrombolysis given: Relatively low mortality rates even with standard treatment (heparin)...