A 40 years old female presented with acute onset shoness of breath. She has a history of nephrotic syndrome 1 year back and recent prolonged air travel. She has a BP of 90/60 mm Hg, hea rate of 115 per minute and sinus tachycardia on ECG. A 2-D echocardiogram revealed dilation of right ventricle with bulging of the interventricular septum to the left. What will be the primary treatment modality?
(A) Thrombectomy (B) Intravenous tissue plasminogen activator (C) Unfractionated heparin (D) d. IVC filter
(B) Ans: B. Intravenous tissue plasminogen activator (Ref: Harrison 19/e p1634-1636, 18/2170-2177)Findings indicate patient most probably suffering from massive pulmonary embolism.Management of Massive Pulmonary Embolism:For patients with massive PE & hypotension, replete volume with 500 mL of normal saline.Additional fluid should be infused with extreme caution-Due to excessive fluid administration exacerbates RV wall stress a more profound RV ischemia & worsens LV compliance and filling.Dopamine & dobutamine - 1st line inotropic agents for PE-related shock treatment.Fibrinolysis in Massive Pulmonary Embolism:Preferred fibrinolytic regimen: Recombinant tissue plasminogen activator (tPA).Contraindications: Intracranial disease, recent surgery & trauma.