Management of Submassive Pulmonary Embolism

Case presentation: A 58-year-oldwoman with a history of cigarette smoking, chronic obstructive pulmonary disease, and recent intensive care unit admission for pneumonia presented with sudden onset of right-sided chest dis-comfort and dyspnea. On physical ex-amination, she was tachycardic (heart rate 110 beats per minute), normotensive (blood pressure of 128/72 mm Hg), tachypneic (24 breaths per minute), and hypoxemic (oxygen saturation 88 % on room air). She had jugular venous dis-tension to the angle of her mandible, a grade 2/6 holosystolic murmur that in-creased to grade 3/6 with inspiration at