emDocs – February 8, 2016 - By Manpreet Singh
Originally published at R.E.B.E.L. EM on April 7, 2015. By Cirilli A.
"Abnormal vital signs are poor predictors of mortality associated with pulmonary embolism (PE). Diagnosis of PE and right ventricular (RV) strain with transthoracic echocardiography (TTE) however, has been well documented as a predictor for pending shock and significant in-hospital mortality. One study done by Grifoni S et al, showed that 10% of normotensive patients with PE and RV strain on echo developed PE related shock, and 3% died, whereas normotensive patients without signs of RV strain remained hemodynamically stable.
- What are the echocardiographic signs of RV dysfunction secondary to PE? (Rudoni et al.)
- What is the most recent literature analyzing the diagnostic accuracy of TTE for PE? (Dresden et al. 2013)
- How does RV strain on TTE perform at predicting outcomes in PE patients? (Taylor et al. 2013)
- What is a Thrombus in Transit on Echo? How does is affect the prognosis of PE? (Byrne, Czuczman, and Hwang 2011)
- How does thrombus in transit on echo affect Prognosis in PE? (Torbicki et al. 2003)
TAKE HOME POINTS
- Point of Care echo is very good for the detection of RV strain
- In the setting of suspected PE, RV strain on echo is not sensitive for the prediction of PE but it is more specific.
- In the setting of hemodynamic instability the detection of RV strain seems to be very specific for PE
- The finding of a right heart thrombus in the setting of PE and RV strain doubles the mortality up to 29%
- Echo identified right heart thrombus most likely requires more aggressive treatment such as embolectomy or lytic therapy compared to heparin alone, however this requires further investigation"