2 year(s) ago
Resolved Question
Lytics for submassive PE?
45 yo, SOB x 3 months, CT showing bilateral saddle emboli. Stable vitals, asymptomatic at rest. EKG showed a new right axis deviation, BNP 1000+, CT did not show RV dilation, Trop normal.
1. BNP, Trop, EKG and CT findings variably predict RV dysfunction. Would anyone treat the patient with lytics before echo?
2. If echo showed RV dysfunction, would you lyse?
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Best Answer - Chosen by Community Voters2 year(s) ago
Good case. There definitely is evidence for RV dysfunction with the EKG/elevated BNP. I would think about lytics and would consider them if the patient decompensated and became hemodynamically unstable. I personally would not push lytics in a patient with normal vitals/asymptomatic at rest--especially with a 3 month history of symptoms. Any cowboys out there?
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