Echocardiographic guided thrombolysis in a patient with massive pulmonary embolism and cardiovascular arrest. A case report

Piérola J.Z.; Salazar J.T.; Díaz L.L.; Makikado L.U.; Muñoz R.C. · Revista Medica Herediana (2024) · DOI: 10.20453/rmh.v35i3.5223

Resumen

Massive pulmonary thromboembolism (PT) is a rare acute vascular event characterized by obstructive shock associated with high mortality. The objective of this report is to emphasize the echocardiographic-guided thrombolytic therapy of a patient with massive PT and cardiovascular arrest. We report the case of a 48-year-old male patient admitted with an open fracture of the left fibula, which was not surgically intervened and not prophylactic anticoagulated, who developed sudden onset of dyspnea, chest pain, and cardiovascular arrest two times; the last one in the ICU. After returning to spontaneous circulation, he developed hypotension, tachycardia, hypoxemia, and a Glasgow coma scale of 4 points. The EKG showed sinus tachycardia, S1Q3T3 pattern, and complete right bundle block. The echocardiography showed a >1 ratio between the right and left ventriculus, McConell positive signs, displacement of the ventricular septum, systolic excursion of the tricuspid ring of 10mm, inferior cava vein of 23mm with <50% collapse. He received the highest doses of noradrenaline, vasopressin, and thrombolysis with 100mg recombinant tissue plasminogen activator followed by sequential echocardiographic monitoring, achieving cardiopulmonary stabilization and resolution of the obstructive shock. He was subsequently successfully discharged from the ICU and the hospital © Revista Médica Herediana.

Instituciones: Universidad Peruana Cayetano Heredia