Interpreting Emerging Evidence in Intermediate‑High Risk Pulmonary Embolism: Implications for Interventional Clinical Performance-Slides

Slides - Case, Dr. Li

Pdf Summary

This case describes a 48-year-old man with nephrolithiasis who developed progressively worsening dyspnea over one week, with symptoms beginning six weeks earlier after starting tamsulosin. He initially attributed the shortness of breath to low blood pressure and reduced the medication to once daily. One week before presentation, he experienced chest “fluttering,” marked worsening exertional dyspnea, and chest tightness, to the point that he could no longer walk around his house. He had no prior venous thromboembolism history and a family history notable for stroke and lung cancer.<br /><br />On presentation, he was mildly hypoxemic (92% on room air, improving to 94% on 2 L nasal cannula) and hemodynamically stable. Key findings included creatinine 1.76 mg/dL, hemoglobin 16.6 g/dL, elevated high-sensitivity troponin (54 ng/L), elevated BNP (729 pg/mL), and normal lactate (1.3 mmol/L). Imaging revealed bilateral popliteal deep vein thromboses, and echocardiographic parameters showed significant right ventricular strain with an RV/LV ratio of 1.8 and RVSP of 64 mmHg.<br /><br />Risk stratification was mixed: PESI score was low risk (78), while BOVA score was stage III/high risk (5), NEWS was 5 (medium risk), and CPES was 5. This combination of findings suggests clinically significant pulmonary embolism with right heart strain despite relative hemodynamic stability.<br /><br />By postoperative day 4, the patient improved clinically: oxygen saturation was 95% on room air, blood pressure and respiratory rate were stable, and RVSP normalized to 28 mmHg, indicating recovery of pulmonary pressures and improvement in right ventricular burden.

Keywords

pulmonary embolism

right ventricular strain

deep vein thrombosis

dyspnea

tamsulosin

hypoxemia

troponin elevation

BNP elevation

PESI score

BOVA score