title: High-dose streptokinase in the treatment of acute massive pulmonary embolism complicated with cardiogenic shock, respiratory arrest and ventricular fibrillation.
abstract: BACKGROUND
  Despite advances in prophylaxis, diagnostic modalities, and therapeutic options, pulmonary embolism remains a commonly undiagnosed entity with lethal outcome. Clinically, pulmonary embolism ranges from massive thromboembolism with cardiogenic shock to asymptomatic, microebolism with anatomically small emboli without hemodynamic, respiratory or other disturbances.
  
  
  METHODS
  A patient with massive pulmonary embolism complicated with ventricular fibrillation, respiratory arrest and cardiogenic shock was treated with a total dose of 3 750 000 IU of intravenous streptokinase in the 8-hour time period. After successful cardiopulmonary resuscitation, and thrombolytic therapy, the patient regained hemodynamic stability six hours after admission; all clinical and electrocardiographic signs of the right ventricle insufficiency disappeared.
  
  
  CONCLUSIONS
  This case report suggested that treatment with the high-dose of streptokinase could be beneficial in the patients with massive pulmonary embolism complicated with cardiogenic shock, which must be confirmed by further randomized trials.
authors.affiliation: Clinical Center of Serbia, Cardiology Department, Emergency Center, Institute for Cardiovascular Diseases, Belgrade, Serbia and Montenegro. Iratko@ptt.yu
authors.forename: Ratko
authors.initials: R
authors.lastname: Lasica
authors.forename: Jovan
authors.initials: J
authors.lastname: Perunicić
authors.forename: Igor
authors.initials: I
authors.lastname: Mrdović
authors.forename: Radan
authors.initials: R
authors.lastname: Stojanović
authors.forename: Zorana
authors.initials: Z
authors.lastname: Vasiljević
mesh_terms: D000208:Acute Disease; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D006801:Humans; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy*; D012131:Respiratory Insufficiency / Q000150:complications*; D012770:Shock, Cardiogenic / Q000150:complications*; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy; D020246:Venous Thrombosis / Q000150:complications; D014693:Ventricular Fibrillation / Q000150:complications*
chemical_list: D013300:Streptokinase