Correct!
4. All of the above

Studies have suggested that right ventricular dysfunction with massive or submassive pulmonary embolism predicts a higher mortality rate (1). Echocardiography as well as the cardiac biomarkers BNP and troponin have been used to detect right ventricular dysfunction. In this patient’s case the echocardiography showed a large mobile density in the pulmonary artery consistent with a pulmonary embolism. In addition, there was a flattened septum with the right ventricle moderately dilated with moderate systolic dysfunction. The troponin and BNP were modestly elevated at 0.3 mcg/L and 477 pg/ml.

Which of the following would be appropriate management decisions?

  1. Catheter-directed embolectomy
  2. Catheter-directed thrombolysis
  3. Intravenous heparin
  4. Low dose thrombolytics
  5. Ultrasound-induced thrombolysis

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