Massive pulmonary embolism requires expeditious diagnosis and aggressive management, often necessitating IVC filters, thrombolysis, or embolectomy in addition to heparin.
May warrant adjunctive interventions beyond heparin in massive PE; leaves open optimal patient selection for IVC filter, thrombolysis, or embolectomy.
The diagnosis of massive pulmonary embolism should be considered expeditiously in all patients with unexplained hypotension, syncope, cardiac arrest, or hypoxemic respiratory failure. The presence of right ventricular overload on physical examination or electrocardiogram is an especially important clue. Depending on local expertise and the patient's stability, V/Q scanning, CT angiography, echocardiography, and right heart catheterization can be useful in establishing a diagnosis of pulmonary embolism. Supportive treatment includes oxygen, vasoactive medicines, and sometimes fluids. Although heparin is important in nearly all patients, 70% to 80% of patients also require an IVC filter, thrombolysis, or embolectomy.
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James R. Gossage (2002) studied this question.
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