An acute central pulmonary embolus (PE) causes pulmonary artery obstruction and elevates pulmonary artery and right ventricular pressures, resulting in right ventricular and atrial strain and dilation. Acute massive PE may produce obstructive shock and subsequent death, and thus an accurate and timely diagnosis is important for the implementation of potentially lifesaving treatments including systemic fibrinolytic therapy or catheter-based treatments. Clinical conditions at the time of presentation that impact patient outcomes include amount of obstruction in the pulmonary artery, preexisting cardiopulmonary disease, and the presence of deep vein thrombus with risk for a second thromboembolic event. Imaging with echocardiography or computed topography (CT), along with cardiac troponins, are often used to guide treatment decisions. In a study by Kasper et al of patients with suspected PE, the presence of right ventricular afterload stress identified during echocardiography was associated with a poor...

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