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Massive pulmonary embolism — SCE Respiratory MCQ

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HardPulmonary Vascular DiseaseMassive pulmonary embolismSCE Respiratory

A 64-year-old woman collapses with acute dyspnoea. BP is 72/44 mmHg, heart rate 132/min and CTPA shows large bilateral pulmonary emboli with right ventricular dilatation. She has no recent surgery or bleeding history. What is the most appropriate management?

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Correct answer: E — Immediate systemic thrombolysis

Massive PE with sustained hypotension and RV strain is high-risk PE, for which immediate reperfusion with systemic thrombolysis is indicated if not contraindicated. D-dimer is redundant after diagnostic CTPA and shock. Outpatient DOAC therapy alone is inadequate for obstructive shock.

Reference: NICE NG158; ESC PE Guideline