Intermediate-Risk and High-Risk Pulmonary Embolism: Recognition and Management Cardiology Clinics : Cardiac Emergencies

While the overall incidence of PE is increasing, the incidence of high -risk PE and mortality from PE is decreasing. This trend suggests that both the recognition of PE generally and the recognition of intermediate-risk and high -risk PE is of paramount importance. Clinicians must remember the protean manifestations of PE and its broad range of presentations. Validated scores for diagnosis and prognosis can guide the clinician. In modern practice, the vast majority of PEs are diagnosed by CTPA. Imaging, in particular TTE, and biomarkers are vital adjuncts to prognosis, but no 1 marker or set of markers is superior, and clinical intuition and individualization are essential. Respiratory and hemodynamic support, attention to volume status, anticoagulation, and consideration for systemic thrombolysis represent the primary management aims of intermediate-high and high -risk PE. There are growing data on CDT and CDE modalities, while surgical thromboembolectomy may also have a role in the initial treatment approach. Because these technologies and therapeutics cross multi-disciplinary lines, and there is equipoise (or lack of data) in preferring 1 advanced PE therapy over another, PERTs can assist the clinician with decision-making and implementation of a treatment plan. While this review provides a broad overview of the recognition and treatment of intermediaterisk and high -risk PE, it does not provide important context for the treatment of special populations with PE including patients who are pregnant, have history of heparin-induced thrombocytopenia, have inherited thrombophilias, or have sickle cell disease.