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Point/Counterpoint Editorials |

Point: Should Systemic Lytic Therapy Be Used for Submassive Pulmonary Embolism? YesLytic Therapy for Pulmonary Embolism? Yes

David Jiménez, MD, PhD
Author and Funding Information

From the Respiratory Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria.

Correspondence to: David Jiménez, MD, PhD, Respiratory Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, 28034 Madrid, Spain; e-mail: djc_69_98@yahoo.com


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflict of interest: Dr Jiménez is a member of the Steering Committee of the Pulmonary Embolism International Thrombolysis Trial.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(2):296-299. doi:10.1378/chest.12-2447
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Extract

Early mortality rates for pulmonary embolism (PE) range from <3% in clinically stable patients to 58% in patients with cardiogenic shock.1 The various mortality rates reported among studies illustrate the heterogeneous clinical and prognostic spectrum in patients with PE.

Studies have provided evidence of PE-associated right ventricular (RV) dysfunction as the most common cause of death during the first 30 days after the diagnosis of PE.2,3 The initial PE, recurrent PE, or underlying cardiopulmonary disease may initiate or exacerbate the cascade of events. Cardiac failure from PE results from a combination of the increased wall stress and cardiac ischemia that compromise RV function and impair left ventricular output. The degree of increase in RV impedance is related predominantly to the interaction of the mechanical obstruction and the underlying cardiopulmonary status.4

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