PREPARED FOR THE WORST, HOPE FOR THE BEST: COLLABORATIVE MEDICINE AGAINST A MASSIVE PULMONARY EMBOLISM IN A YOUNG WOMAN

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

oral contraceptive agent, adult, anticoagulation, backache, blood clot lysis, cardiopulmonary bypass, cardiovascular mortality, case report, catheterization, clinical article, conference abstract, diagnosis, dizziness, drug therapy, dyspnea, echocardiograph, echocardiography, embolectomy, female, follow up, human, hypotension, hypoxia, intravenous drug administration, lung embolism, medical history, mortality risk, obesity, oral drug administration, right ventricular dilatation, risk factor, surgery, tachycardia, thrombectomy

Abstract

Background: Approximately 900,000 Americans experience pulmonary embolisms (PEs) each year, with 5-10% of those classified as high-risk or massive PE. The mortality risk for an untreated massive PE is alarmingly high, ranging from 30-60% within hours of onset. Even with prompt treatment, it remains one of the leading causes of cardiovascular death. Treatment requires a multifaceted, coordinated team approach that considers the patientʼs clinical condition, risk factors, and contraindications (CIs). Case A 24-year-old woman with a past medical history of obesity, oral contraceptive therapy, and back pain presented to a communityhospital with tachycardia, lightheadedness, and shortness of breath after a recent epidural spinal injection (ESI). She was diagnosed with a massive saddle PE and quickly became hemodynamically unstable with hypoxia and hypotension. A STAT echocardiogram demonstrated a severely dilated right ventricle (RV) with evidence of strain and a small, hyperdynamic left ventricle. Decision-making Neurosurgery was consulted due to the relative CI for thrombolysis after an ESI and determined the patient to be at an acceptable risk to proceed with thrombectomy and anticoagulation. She was urgently transported to the catheterization lab. A cardiothoracic surgeon (CTS) was present during the case with cardiopulmonary bypass prepped along with a pharmacist with thrombolysis if needed. Patient underwent a successful transfemoral embolectomy and was closely monitored. She was later initiated on oral anticoagulation. At her two-month follow-up, she was doing well with her echocardiogram demonstrating an exceptional, complete recovery of her RV. Conclusion This case emphasizes the importance of collaborative multidisciplinary care in a rural-hospital setting, especially in high-risk cases. Obtaining Neurosurgery clearance in an urgent manner helped expedite treatment. Having CTS and their team on standby, as well as a pharmacist with thrombolysis, allowed for alternative treatment options that could be seamlessly initiated. Coordinating care to this degree is uncommon, but vital in optimizing the utilization of all available resources when dealing with a massive PE.

Volume

85

Issue

12

First Page

3815

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