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Acute pulmonary embolism with RV strain — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsAcute pulmonary embolism with RV strainSCE Acute Medicine

A 64-year-old woman presents with pleuritic chest pain and syncope 10 days after knee replacement. Blood pressure is 112/68 mmHg, pulse 118/min, oxygen saturation 91% on air and JVP is elevated. ECG shows sinus tachycardia with anterior T-wave inversion and troponin is mildly raised. CTPA confirms bilateral pulmonary emboli with right ventricular dilatation. What is the most appropriate next step in management?

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Correct answer: A — Start therapeutic anticoagulation and admit for monitored care

The patient has confirmed pulmonary embolism with evidence of right ventricular strain but no persistent hypotension, so therapeutic anticoagulation with inpatient monitoring is the best next step. Systemic thrombolysis is generally reserved for haemodynamic compromise or cardiac arrest because of bleeding risk. D-dimer is not useful once imaging has confirmed the diagnosis. The teaching point is that RV strain changes risk stratification and site of care, not necessarily first-line reperfusion treatment.

Reference: NICE NG158; ESC PE guidance