Pulmonary embolism commonly produces hemodynamic compromise through an acute elevation in right ventricular afterload. Right ventricular dysfunction, which is universal in this setting, is easily detected with echocardiography. Along with clinical evidence of shock, such disfunction selects a group of patients who will likely benefit from an aggressive approach to reduction of clot burden and prevention of right ventricular ischemia. In general, these aims are best achieved using thrombolysis and augmentation of right ventricular coronary perfusion pressure.
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