Template:PE types

Pulmonary Embolism Types

Massive: High-risk

• Hemodynamically unstable
• ACCP 2016 Guidelines: Sustained hypotension (systolic BP <90 for at least 15min or requiring inotropic support) ONLY
• Previous definitions (AHA 2011) include Cardiac arrest/pulselessness or Persistent profound bradycardia (HR <40 with signs of shock)

Submassive: Intermediate-risk

Right ventricular dysfunction (RVD) and/or myocardial necrosis in the absence of persistent hypotension or shock (SBP >90)

• RV dysfunction
  • RV dilation or dysfunction on TTE
    • "D Sign" on bedside echo (LV takes on a "D" shape due to RV dilation)
  • RV dysfunction on CT defined as RV/LV ratio >0.9
  • Elevation of BNP (>90)
  • ECG findings of right heart strain (see diagnosis below)
• Myocardial necrosis: Troponin I >0.4

Non-Massive

• No hemodynamic compromise and no RV strain

Sub-Segmental

• Limited to the subsegmental pulmonary arteries