1. Kahn SR, de Wit K. Pulmonary Embolism. N Engl J Med 2022;387(1):45-57. doi:10.1056/NEJMcp2116489

Nearly all pulmonary emboli arise from thrombi in the veins of the legs or pelvis ( deep venous thrombosis Тромбоз глибоких вен (ТГВ) $\"Тромбоз$ ). Risk of embolization is higher with thrombi that reach the popliteal vein or above. Thromboemboli can also originate in arm veins or central veins of the chest (caused by central venous catheters or resulting from thoracic outlet syndromes).

Once deep venous thrombosis develops, clots may dislodge and travel through the venous system and the right side of the heart to lodge in the pulmonary arteries, where they partially or completely occlude one or more vessels. The consequences depend on the size and number of emboli, the underlying condition of the lungs, how well the right ventricle (RV) is functioning, and the ability of the body’s intrinsic thrombolytic system to dissolve the clots. Death, when is does occur, is often due to right ventricular failure.

Many pulmonary emboli are small, physiologically insignificant, and asymptomatic. Even when present, symptoms are nonspecific and vary in frequency and intensity, depending on the extent of pulmonary vascular occlusion and preexisting cardiopulmonary function.

High index of suspicion

Supportive therapy

Initial anticoagulation followed by maintenance anticoagulation is indicated for patients with acute pulmonary embolism to prevent further embolization as well as new clot formation. Anticoagulant therapy for acute PE should be started whenever PE is strongly suspected, as long as the risk of bleeding is deemed low. Otherwise, anticoagulation should be started as soon as the diagnosis is made. Time to therapeutic anticoagulation has been found to have an impact on mortality. Patients who attain therapeutic anticoagulation within 24 hours have been found to have a significant improvement in hospital mortality as well as 30 day mortality ( 1 Довідкові матеріали щодо антикоагулянтної терапії Pulmonary embolism (PE) is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis. Risk factors for pulmonary embolism are... прочитати більше $\"Довідкові$ ).

Clot elimination by means of embolectomy or dissolution with IV or catheter-based thrombolytic therapy should be considered for acute pulmonary embolism associated with hypotension that does not resolve after fluid resuscitation (high-risk/massive PE) ( 1 Довідкові матеріали щодо швидкого зменшення тромбоутворення Pulmonary embolism (PE) is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis. Risk factors for pulmonary embolism are... прочитати більше $\"Довідкові$ ). Patients who are hypotensive and require vasopressor therapy are obvious candidates. Patients with a systolic blood pressure < 90 mm Hg or a decrease from baseline value in systolic blood pressure > 40 mm Hg that lasts at least 15 minutes despite fluid challenge are hemodynamically compromised and are also candidates.

Most deaths resulting from pulmonary embolism occur within 1 hour of presentation ( 1 Довідкові матеріали щодо прогнозу Pulmonary embolism (PE) is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis. Risk factors for pulmonary embolism are... прочитати більше $\"Довідкові$ ). Most patients who die as a result of acute PE are never diagnosed before death. In fact, PE is not suspected in most of these patients. Overall in-hospital mortality rate ranges from approximately 8% in stable patients to 25% in those presenting with cardiogenic shock and to 65% in patients requiring cardiopulmonary resuscitation ( 2 Довідкові матеріали щодо прогнозу Pulmonary embolism (PE) is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis. Risk factors for pulmonary embolism are... прочитати більше $\"Довідкові$ ).

Prevention of pulmonary embolism means prevention of deep venous thrombosis Профілактика тромбозу глибоких вен (ТГВ) (DVT); the need depends on the patient’s risks, including

Acute pulmonary embolism (PE) is a common and potentially devastating medical condition.