A pulmonary saddle embolus can have a clinical impact that ranges from life-threatening to relatively benign. It is important to recognize since its presence impacts prognosis and management.
A saddle embolism is a thrombus that straddles the bifurcation of the pulmonary artery, often with extensions into the left and right pulmonary arteries.
not massive; right ventricular dilatation AND/OR evidence of myocardial injury (elevated serum troponin, etc)
submassive
none of the above
low-risk
where:
• Hemodynamic instability involves hypotension (systolic blood pressure < 90 mm Hg for >= 15 minutes) or need for vasopressors (inotropic support, excluding other cause (sepsis, hypovolemia, arrhythmia, etc)
Hazards of a saddle embolus:
(1) risk for massive or submassive presentation
(2) risk for late decompensation after admission
(3) risk for increased 30-day morbidity and mortality
(4) risk for additional deep vein thrombosis and thromboembolism
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