What question did this study set out to answer?

To present a case of high-risk pulmonary thromboembolism and evaluate treatment strategies based on ESC guidelines.

January 17, 2026Srce i krvni sudovi0 citationsOpen Access

Diagnostic and therapeutic approach to a patient with high-risk pulmonary thromboembolism: A case report and commentary in the context of ESC guidelines

MNMilan Nikolić VMVladimir Mitov AJAleksandar Jolić

Key Result

Systemic fibrinolytic therapy with alteplase stabilized a 70-year-old patient with high-risk pulmonary thromboembolism, leading to resolution of thrombus and discharge after 12 days.

Key Points

To present a case of high-risk pulmonary thromboembolism and evaluate treatment strategies based on ESC guidelines.
Patient assessment in the intensive care unit
Risk stratification as per ESC guidelines
Use of systemic fibrinolytic therapy with alteplase
Monitoring electrocardiographic and echocardiographic changes
Patient stabilized hemodynamically post-treatment
Resolution of electrocardiographic changes associated with PTE
Thrombus resolved in the right heart chambers
Patient discharged after 12 days of treatment

Structured PICO

Population

1 70-year-old male patient with high-risk pulmonary thromboembolism presenting with hypotension, dyspnea, diaphoresis, signs of organ hypoperfusion, S1Q3T3 sign, right bundle branch block, and a large mobile thrombotic mass prolapsing from the right atrium to the right ventricle.

Intervention

Systemic fibrinolytic therapy with alteplase and concomitant unfractionated heparin infusion.

Outcome

Hemodynamic stabilization, resolution of electrocardiographic changes, and thrombus resolution.

This case report demonstrates the successful use of systemic fibrinolytic therapy for high-risk pulmonary thromboembolism, supporting current ESC guideline recommendations.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Pulmonary thromboembolism (PTE) is a common and potentially fatal disease for the diagnosis and treatment of which European Society of Cardiology (ESC) guidelines have been published in 2019. They emphasize the importance of risk stratification of early mortality in suspected or confirmed PTE and treatment according to the risk class: use of anticoagulant or systemic fibrinolytic therapy. The aim of this paper is to present a patient with typical electrocardiographic and echocardiographic findings stratified as high - risk PTE who was treated with systemic fibrinolytic therapy. A 70-year-old patient was admitted to the Intensive Care Unit of the Department of internal medicine of the Zajecar Health Center. On admisson he was hypotensive, dyspnoeic, diaphoretic with signs of organ hypoperfusion. Electrocardiographically, the S1Q3T3 sign and right bundle branch block (RBBB) were verified and a high-risk PTE suspected. Bedside echocardiographic exam revealed a large, mobile thrombotic mass that prolapses from the right atrium to the right ventricle. Systemic fibrinolytic therapy with alteplase with concomitant unfractionated heparin infusion was given. The patient hemodynamically stabilized with loss of electrocardiographic changes suggestive of PTE and thrombus resolution in the right heart chambers. The patient was discharged home after 12 days of hospital treatment. Early risk stratification of patients with PTE and development of a local protocol for diagnosis and treatment according to the risk class increases the success rate in recognizing and treating this disease and reduces the risk of death and other adverse clinical events.

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