Regional Right Ventricular Dysfunction Detected by Echocardiography in Acute Pulmonary Embolism

Saddle pulmonary embolism: Is it as bad as it looks? A community hospital experience*

“…Patients with underlying cardiopulmonary disease (CPD) would have excess risk of an adverse outcome with the amount clot burden produced by a SPE. (17,28). Wood (8) however, reported no consistent relationship between the degree of cardiovascular and RV impairment and the magnitude of angiographic obstruction in those with underlying CPD..…”

“…Most authors define shock as a SBP <90mmHg (17) while others have used a threshold < 100mmHg (18). We elected to define it as a sustained or persistent systolic blood pressure ≤ 90 mmHg in more than one blood pressure measurement at presentation, and after ≥ 500 ml of intravenous crystalloid solutions, requirement of cardio-pulmonary resuscitation (CPR) or the use of vasoactive pressors.…”

Pulmonary embolism in transit: direct visualization of a PE passing through the heart using bedside ultrasonography

“…1 Recommendations are limited, but favor thrombolysis or embolectomy rather than anticoagulation alone. 2 Although typical echocardiogram findings suggestive of PE include RV strain and McConnell's sign (RV free wall hypokinesis with preserved apical contractility), 3 this patient had neither of these findings, but the presence of a right-sided thrombus confirmed the likely diagnosis of PE and …”

Thrombolytic Therapy in a Patient With Suspected Pulmonary Embolism Despite a Negative Computed Tomography Pulmonary Angiogram

“…The McConnell sign (regional variations of RV systolic wall motion abnormalities, with sparing of the apex), when prospectively tested in 85 patients, had a sensitivity of 77% and a specificity of 94% for the diagnosis of acute pulmonary embolism. 7 More recently, Lodato et al reported the right-and left-ventricular end-diastolic dimension as the most accurate echocardiographic predictor of pulmonary embolism in patients referred for helical CT, but found the McConnell sign to be most specific (96%). 8 This finding resolved in our patient after thrombolytic therapy.…”