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PE Risk Stratification — FRCA Final MCQ

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HardIntensive Care MedicinePE Risk StratificationFRCA Final

A 50-year-old woman (ASA III) has a CT pulmonary angiogram showing bilateral segmental pulmonary emboli with a right ventricular to left ventricular ratio of 1.2 on CT. She is haemodynamically stable (BP 110/70, HR 100). Her troponin is mildly elevated. According to ESC guidelines, what risk category is she in?

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Correct answer: C — Intermediate-high risk

This patient has haemodynamically stable PE with evidence of RV dysfunction (RV:LV ratio >1.0 on CT) AND elevated troponin – classifying her as intermediate-high risk (submassive PE) according to the ESC 2019 guidelines. Management: anticoagulation with LMWH or unfractionated heparin, close monitoring in a high-dependency setting, and consideration of rescue thrombolysis/catheter-directed therapy if she deteriorates. Routine thrombolysis is NOT indicated for intermediate-risk PE (PEITHO trial showed harm from increased bleeding).

Reference: ESC – 2019 – Guidelines on PE; NICE – 2020 – NG158 VTE; Konstantinides S – 2014 – PEITHO trial