Haemodynamic consequences of pulmonary embolism

Abstract

Acute pulmonary embolism is defined by the occurrence of right ventricular failure secondary to an increase in ventricular afterload. The existence of hypotension, peripheral signs of shock and/or right ventricular dysfunction are associated with a mortality excess. The interactions between the pulmonary vascular anomalies, the function of the left and right ventricles and the coronary circulation reflect the haemodynamic changes seen at the different stages of acute pulmonary embolism. Echocardiography allows the haemodynamic consequences of pulmonary embolism to be determined, as well as certain other scan indicators. Over the last few years, research has been focused on patients at intermediate risk, i.e. not hypotensive but presenting with echocardiographic signs of right ventricular dysfunction, as well as an increase in myocardial markers (proBNP [brain natriuretic peptide], BNP and troponin). The place for different symptomatic or etiological therapeutic treatments are discussed.