ZyraDoc #07 - August 09, 2026

A 58-year-old man is diagnosed with acute pulmonary embolism and started on therapeutic anticoagulation with continuous IV unfractionated heparin.

Two hours into treatment, he reports severe worsening breathlessness, diaphoresis, and sudden lightheadedness.

His repeat vital signs demonstrate acute hemodynamic collapse with severe hypotension (82/50 mmHg), persistent tachycardia (132 bpm), and signs of right ventricular shock.

Case Summary

Clinical Focus:

A 58-year-old male with acute pulmonary embolism deteriorates rapidly despite first-line IV unfractionated heparin, developing obstructive shock and severe hypotension (systolic BP < 90 mmHg).

Diagnosis of Massive Pulmonary Embolism include:

Acute PE accompanied by sustained hypotension (systolic BP < 90 mmHg for ≥ 15 minutes) or shock
Rapid hemodynamic instability not explained by hypovolemia, sepsis, or acute arrhythmia
Echocardiographic or CT evidence of acute right ventricular strain and overload

When anticoagulated pulmonary embolism rapidly progresses to hemodynamic collapse (massive PE), systemic thrombolytic therapy becomes the urgent rescue intervention of choice.

Here is the Management Strategy:

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