A 45-year-old woman on ICU develops acute right heart failure following a massive pulmonary embolism. RV is severely dilated on echocardiography with ...

Question

A 45-year-old woman on ICU develops acute right heart failure following a massive pulmonary embolism. RV is severely dilated on echocardiography with interventricular septal bowing. BP is 75/50 despite noradrenaline 0.3 mcg/kg/min. She has received systemic thrombolysis with alteplase but remains unstable 2 hours later. What is the next best management step?

Accepted Answer

Referral for catheter-directed therapy or surgical embolectomy

Answer

Repeat systemic thrombolysis with another full dose of alteplase

Answer

Increase noradrenaline to 1.0 mcg/kg/min

Answer

Commence IV heparin only and observe

Answer

Insert an IVC filter

uk-fficm MCQ (SBA): Failed Thrombolysis for PE