Overview
Clinical Meaning
Pulmonary embolism causes acute right ventricular pressure overload from mechanical vascular obstruction and vasoactive mediator release.
CNPLE
CNPLE
Pulmonary embolism causes acute right ventricular pressure overload from mechanical vascular obstruction and vasoactive mediator release. When > 30-50% of the pulmonary vascular bed is occluded, the thin-walled RV fails to generate adequate systolic pressures against the increased afterload. RV dilation causes interventricular septal shift (D-sign), impairs LV filling, and reduces cardiac output. V/Q mismatch from perfused but non-ventilated and ventilated but non-perfused lung units causes hypoxemia. Dead space ventilation increases (high V/Q regions), producing tachypnea. The Wells criteria pre-test probability score guides diagnostic testing: low probability (< 2 points) + negative age-adjusted D-dimer safely excludes PE. CTPA is the definitive imaging test. Risk stratification (PESI/sPESI) combined with RV function assessment and biomarkers determines management intensity from outpatient anticoagulation to systemic thrombolysis.
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