title: Practical echocardiographic approach for risk stratification of patients with acute pulmonary embolism.
abstract: Acute pulmonary embolism remains a common cause of mortality. Early diagnosis and appropriate risk stratification is necessary to individualize treatment strategy. Computed tomography scan of the pulmonary arteries is routinely used to diagnose acute pulmonary embolism and in some cases is useful to assess right ventricular dilation. In patients with acute pulmonary embolism, right ventricular dilation and dysfunction indicates a high-risk situation where immediate administration of thrombolytic agent, catheter-directed thrombolysis, or surgical embolectomy could be considered. A bedside 2D echocardiogram at the time of presentation could provide additional morphological, functional, and hemodynamic parameters including right ventricular dilation, McConnell's sign, reduced tricuspid annular plane systolic excursion (TAPSE), interventricular septal flattening, abnormal right ventricular hemodynamics and in rare cases thrombi in the inferior vena cava, right atrium or ventricle en route to pulmonary arteries may also be visualized. This additional information is useful for selection of appropriate treatment modality. Thus, our objective is to provide a practical echocardiographic approach for risk stratification of patients with acute pulmonary embolism.
authors: Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, M.S. 1118, Toledo, OH, 43614, USA.
authors: Qaiser
authors: Q
authors: Shafiq
authors: Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, M.S. 1118, Toledo, OH, 43614, USA.
authors: George V
authors: GV
authors: Moukarbel
authors: Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, M.S. 1118, Toledo, OH, 43614, USA.
authors: Rajesh
authors: R
authors: Gupta
authors: Division of Pulmonary, Critical Care and Sleep Medicine, University of Toledo Medical Center, Toledo, OH, USA.
authors: Dawn-Alita
authors: DA
authors: Hernandez
authors: Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, M.S. 1118, Toledo, OH, 43614, USA. samer.khouri@utoledo.edu.
authors: Samer J
authors: SJ
authors: Khouri
mesh_terms: D004452:Echocardiography; D017128:Embolectomy; D006801:Humans; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012306:Risk; D018497:Ventricular Dysfunction, Right
keywords: Computed tomography; Echocardiogram; Pulmonary artery; Pulmonary embolism; Right ventricle