Hemodynamic Deterioration in Acute Pulmonary Embolism: A Clinical Case Report

Background: Acute pulmonary embolism (PE) is a common medical emergency that can rapidly become fatal. In massive PE, occlusion of the pulmonary vasculature precipitates systemic hemodynamic instability and, without intervention, cardiovascular collapse. Timely systemic thrombolysis markedly improves survival in these high-risk cases; however, in many low-resource environments, diagnostic bottlenecks—limited imaging, delayed laboratory results, and logistical constraints—frequently postpone therapy. Clinicians in such settings must weigh the bleeding risk of fibrinolytics against the imminent threat of circulatory failure, often relying on bedside assessment and expedited protocols to deliver life-saving treatment. This study aims to delineate these challenges, present real-world outcomes of prompt thrombolytic intervention under resource constraints, and propose pragmatic strategies for accelerating reperfusion therapy in similar settings.
Case Summary: We present a 42-year-old chronic smoker with acute PE who deteriorated hemodynamically (blood pressure drop from 130/70 mmHg to 86/67 mmHg; SpO₂ 76 %) while awaiting advanced imaging. Bedside transthoracic echocardiography (TTE) revealed multiple echogenic masses in the main pulmonary artery and right ventricle with severe tricuspid regurgitation (Vmax 3.8 m/s, estimated PASP 56 mmHg). Systemic alteplase (100 mg over 2 h) produced rapid clinical recovery and oxygenation (SpO₂ 92–95 % within 6 h). This case underscores the utility of bedside echo for rapid risk stratification and the feasibility of guideline-directed systemic thrombolysis in a resource-poor setting when computed tomography pulmonary angiography (CTPA) is either unavailable or delayed.
Conclusion: Training frontline physicians in point-of-care echocardiography and ensuring ready access to thrombolytics can be lifesaving in sub-Saharan Africa.