A 40 years old female presented with acute onset shoness of breath. She has a history of nephrotic syndrome 1 year back and recent prolonged air travel. She has a BP of 90/60 mm Hg, hea rate of 115 per minute and sinus tachycardia on ECG. A 2-D echocardiogram revealed dilation of right ventricle with bulging of the interventricular septum to the left. What will be the primary treatment modality?

Ans: B. Intravenous tissue plasminogen activator (Ref: Harrison 19/e p1634-1636, 18/2170-2177)Findings indicate patient most probably suffering from massive pulmonary embolism.Management of Massive Pulmonary Embolism:For patients with massive PE & hypotension, replete volume with 500 mL of normal saline.Additional fluid should be infused with extreme caution-Due to excessive fluid administration exacerbates RV wall stress a more profound RV ischemia & worsens LV compliance and filling.Dopamine & dobutamine - 1st line inotropic agents for PE-related shock treatment.Fibrinolysis in Massive Pulmonary Embolism:Preferred fibrinolytic regimen: Recombinant tissue plasminogen activator (tPA).Contraindications: Intracranial disease, recent surgery & trauma.