Thrombolytic Therapy in a Patient with Extensive Pulmonary Embolism Complicated by Cardiac Arrest

Abstract

Pulmonary embolism is the third most frequently-occurring cause of death after cerebrovascular accidents and myocardial infarction. This condition can occur as a result of a thromboembolic event due to recent immobilization. Massive pulmonary thromboembolism is a life-threatening condition that can cause cardiac arrest, stroke, and eventually death. The present case report discusses the case of a 60-year-old obese, non-insulin-dependent diabetic male admitted to the emergency room with complaints of shortness of breath and fatigue. Previously, the patient was diagnosed with a meniscal and anterior cruciate ligament tear following a work-related knee injury. Echocardiogram showed S1 Q3 T3, and a transthoracic echocardiography demonstrated significant right ventricle dilatation and cardiac strain. Laboratory investigations showed higher levels of D Dimer and a computerized tomography pulmonary angiogram was also conducted. An obvious extensive saddle-shaped pulmonary artery (PA) embolism was detected at the bifurcation, which extended to both right and left pulmonary arteries. This extensive pulmonary embolism led to the patient’s acute deterioration due to cardiogenic shock. The patient went through nine cycles of cardiac abnormality for 18 minutes and was treated with cardiopulmonary resuscitation and thrombolytic therapy accordingly. The diagnosis of pulmonary embolism was made based on the history of immobilization as a result of knee injury and the clinical picture of shortness of breath and tachycardia. This case study will explore how the patient was diagnosed and managed with thrombolytic therapy in conjunction with CPR to relieve cardiac arrest caused by pulmonary embolism and subglottal laryngeal edema.