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Monitoring and Management of Acute Pulmonary Embolism

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Cardiopulmonary Monitoring

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Abstract

Acute pulmonary embolism (PE) is a commonly encountered medical condition that can lead to right ventricle compromise, systemic hypotension, and hemodynamic collapse. Early recognition of intermediate and high-risk PEs can help to reduce the likelihood of worsening clinical status. The diagnosis of PE can be aided by the use of computed tomography angiography (CTA), transthoracic echocardiogram (TTE), and laboratory testing in the form of cardiac troponin, brain natriuretic peptide (BNP), and d-dimer. The clinical deterioration that can be associated with PEs is driven by a combination of thrombus formation as well as vasoconstriction within the pulmonary vasculature. These two elements work in conjunction to increase right ventricle (RV) afterload, to increase pulmonary vasculature resistance, and to decrease RV stroke volume. In the setting of increased pressure, the RV dilates resulting in decreased cardiac output as the interventricular septum shifts into the left ventricle (LV) cavity. Clot burden can be addressed with anticoagulation in low-risk cases; however intermediate and high-risk cases may involve systemic thrombolysis, catheter-directed therapy, surgical embolectomy, or extracorporeal membrane oxygenation (ECMO). Along with addressing the clot, in the setting of hypotension, vasopressors and inotropic support may be needed to maintain RV perfusion.

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Authors and Affiliations

  1. Massachusetts General Hospital, Department of Pulmonary and Critical Care, Boston, MA, USA

    Jenna McNeill

  2. UCLA Medical Center, UCLA David Geffen School of Medicine, Pulmonary and Critical Care Division, Los Angeles, CA, USA

    Richard N. Channick

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  1. Jenna McNeill
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Correspondence to Jenna McNeill .

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Editors and Affiliations

  1. Royal Victoria Hospital (McGill University Health Centre), Departments of Critical Care and Physiology McGill University, Montreal, QC, Canada

    Sheldon Magder

  2. UC San Diego, Department of Medicine, La Jolla, CA, USA

    Atul Malhotra

  3. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Kathryn A. Hibbert

  4. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Charles Corey Hardin

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McNeill, J., Channick, R.N. (2021). Monitoring and Management of Acute Pulmonary Embolism. In: Magder, S., Malhotra, A., Hibbert, K.A., Hardin, C.C. (eds) Cardiopulmonary Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-73387-2_55

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