Use of Tachycardia in Patients With Submassive Pulmonary Emboli to Risk Stratify for Early Initiation of Thrombolytic Therapy: A Case Series Comparing Early Versus Late Thrombolytic Initiation

Abstract

Pulmonary embolism (PE) represents a prevalent cause of morbidity and mortality in the United States, with approximately 600 000 cases diagnosed annually. The mortality rate for untreated PE is as high as 30%. Right ventricular (RV) dysfunction is a sign of possible adverse outcomes with right-sided heart failure being the usual cause of death from PE. There is a spectrum of clinical presentations associated with PE diagnoses, from incidental and asymptomatic to rapid hemodynamic collapse. Despite successes in identifying patients with “high-risk” PEs for aggressive thrombolytic interventions and “low-risk” PEs for outpatient anticoagulation, a significant lack of consensus exists regarding intervention modalities for PEs identified as “intermediate risk” or “submassive,” defined as normotensive (systolic blood pressure ≥90 mm Hg) with acute RV dysfunction and myocardial injury. In this case series, we review the management and outcomes of 2 patients with submassive PEs and sustained tachycardia in the setting of normal blood pressures, and we address the need to recognize tachycardia as an ominous RV compensatory sign, indicative of impending hemodynamic collapse, that should lead to aggressive therapy with vascular intervention.

S1Q3T3 Pattern or McGinn-White Sign: Prevalence and Distribution among Apparently Healthy Young Adult Nigerians

“…This present study showed that asymptomatic young adults could have S1Q3T3 pattern which is also more prevalent in females. However, among the participants in this study, the electrocardiographic pattern was associated with normal heart rate unlike the clinical cases of pulmonary embolism usually characterized by tachycardia [28][29][30][31] . The finding of S1Q3T3 pattern among healthy young adults in this study was surprising because it is rarely reported in literature.…”

Intraoperative development of pulmonary thromboembolism in a bedridden patient owing to a pelvic bone fracture with negative preoperative computed tomography pulmonary angiographic findings

“…[16] Accordingly, sustained tachycardia and normal blood pressure were observed in clinical settings. [17] In addition, the Wells score and revised Geneva score that were developed to predict the probability of PTE have heart rate (>100 and ≥ 95 beats/min, respectively) as one of the predictive variables. [8,9] Particularly, the heart rate of ≥95 beats/min has the highest score among the variables included in the revised Geneva score.…”

“…The increased afterload causes right ventricular dysfunction and dilatation that displace the interventricular septum towards the left leading to a reduction in cardiac output and systemic arterial blood pressure, which is compensated for by tachycardia [16] . Accordingly, sustained tachycardia and normal blood pressure were observed in clinical settings [17] . In addition, the Wells score and revised Geneva score that were developed to predict the probability of PTE have heart rate (>100 and ≥ 95 beats/min, respectively) as one of the predictive variables [8,9] .…”