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Editor's Correspondence
February 12, 2001

Treatment of Massive Pulmonary Embolism—Reply

Arch Intern Med. 2001;161(3):481-482. doi:

In reply

The treatment of patients with PE and cardiogenic shock still remains a challenge to the attending physician. Mortality rates are high, especially within the first hours of the onset of symptoms.1

Right ventricular function is one of the determinate factors concerning the outcome of patients with massive PE, and rapid reduction of right ventricular afterload is the decisive therapeutic step. The resolution of obstructing emboli by thrombolysis, catheter fragmentation, or invasive embolectomy is the therapy of choice, depending on local facilities, but additional procedures are essential in this life-threatening situation. Apart from hemodynamic support by the use of catecholamines and volume expansion, the reversion of mediator-associated pulmonary vasoconstriction seems to be an important pathway to increase cardiac output. Treatment with various vasodilatators, such as isoproterenol and nitrates, has failed because of the concomitant reduction of systemic blood pressure levels.2