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Massive Pulmonary Embolism — EECC MCQ

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EasyPulmonary Vascular DiseaseMassive Pulmonary EmbolismEECC

A 50-year-old woman presents with acute massive pulmonary embolism (PE) with a systolic BP of 80 mmHg, HR 120 bpm, and RV dilatation with dysfunction on bedside echocardiography. She has no contraindication to thrombolysis. What is the most appropriate immediate management?

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Correct answer: B — Systemic thrombolysis with alteplase 100 mg over 2 hours and concurrent unfractionated heparin

Massive (high-risk) PE is defined by haemodynamic instability (SBP <90 mmHg or requiring vasopressors) with RV dysfunction. The ESC PE Guidelines recommend systemic thrombolysis as first-line reperfusion therapy (Class I, LOE B) in the absence of contraindications. Alteplase 100 mg IV over 2 hours is the standard regimen, with concurrent unfractionated heparin. Surgical embolectomy or catheter-directed therapy are alternatives when thrombolysis is contraindicated or has failed. LMWH alone is insufficient for massive PE with haemodynamic compromise. Thrombolysis reduces mortality in massive PE from ~30% to ~5%.

Reference: ESC (2019): Guidelines on Acute Pulmonary Embolism