From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary Embolism

Massive pulmonary embolism (MPE) is a serious condition affecting the pulmonary arteries and is difficult to diagnose, triage, and treat. The American College of Chest Physicians (AHA) and the European Society of Cardiology (ESC) have different classification approaches for PE, with the AHA defining...

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Main Author: Pavan Thangudu
Format: Article
Language:English
Published: Houston Methodist DeBakey Heart & Vascular Center 2024-05-01
Series:Methodist DeBakey Cardiovascular Journal
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Online Access:https://account.journal.houstonmethodist.org/index.php/up-j-mdbcj/article/view/1345
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author Pavan Thangudu
author_facet Pavan Thangudu
author_sort Pavan Thangudu
collection DOAJ
description Massive pulmonary embolism (MPE) is a serious condition affecting the pulmonary arteries and is difficult to diagnose, triage, and treat. The American College of Chest Physicians (AHA) and the European Society of Cardiology (ESC) have different classification approaches for PE, with the AHA defining three subtypes and the ESC four. Misdiagnosis is common, leading to delayed or inadequate treatment. The incidence of PE-related death rates has been increasing over the years, and mortality rates vary depending on the subtype of PE, with MPE having the highest mortality rate. The current definition of MPE originated from early surgical embolectomy cases and discussions among experts. However, this definition fails to capture patients at the point of maximal benefit because it is based on late findings of MPE. Pulmonary Embolism Response Teams (PERTs) have emerged as a fundamental shift in the management of MPE, with a focus on high-risk and MPE cases and a goal of rapidly connecting patients with appropriate therapies based on up-to-date evidence. This review highlights the challenges in diagnosing and managing MPE and emphasizes the importance of PERTs and risk stratification scores in improving outcomes for patients with PE.
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spelling doaj-art-0666a0d08c5e4f6dadd90e1e9e60702c2025-08-20T03:47:06ZengHouston Methodist DeBakey Heart & Vascular CenterMethodist DeBakey Cardiovascular Journal1947-61082024-05-01203192610.14797/mdcvj.13451322From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary EmbolismPavan Thangudu0https://orcid.org/0009-0007-5323-1311Pulmonary Disease & Critical Care, Memorial Hermann Health System, The Woodlands, TexasMassive pulmonary embolism (MPE) is a serious condition affecting the pulmonary arteries and is difficult to diagnose, triage, and treat. The American College of Chest Physicians (AHA) and the European Society of Cardiology (ESC) have different classification approaches for PE, with the AHA defining three subtypes and the ESC four. Misdiagnosis is common, leading to delayed or inadequate treatment. The incidence of PE-related death rates has been increasing over the years, and mortality rates vary depending on the subtype of PE, with MPE having the highest mortality rate. The current definition of MPE originated from early surgical embolectomy cases and discussions among experts. However, this definition fails to capture patients at the point of maximal benefit because it is based on late findings of MPE. Pulmonary Embolism Response Teams (PERTs) have emerged as a fundamental shift in the management of MPE, with a focus on high-risk and MPE cases and a goal of rapidly connecting patients with appropriate therapies based on up-to-date evidence. This review highlights the challenges in diagnosing and managing MPE and emphasizes the importance of PERTs and risk stratification scores in improving outcomes for patients with PE.https://account.journal.houstonmethodist.org/index.php/up-j-mdbcj/article/view/1345massive pulmonary embolismpulmonary embolism classificationpulmonary embolism misdiagnosispulmonary embolism response teams (perts)
spellingShingle Pavan Thangudu
From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary Embolism
Methodist DeBakey Cardiovascular Journal
massive pulmonary embolism
pulmonary embolism classification
pulmonary embolism misdiagnosis
pulmonary embolism response teams (perts)
title From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary Embolism
title_full From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary Embolism
title_fullStr From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary Embolism
title_full_unstemmed From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary Embolism
title_short From Trendelenburg to PERTs: Evolution in the Management of Massive Pulmonary Embolism
title_sort from trendelenburg to perts evolution in the management of massive pulmonary embolism
topic massive pulmonary embolism
pulmonary embolism classification
pulmonary embolism misdiagnosis
pulmonary embolism response teams (perts)
url https://account.journal.houstonmethodist.org/index.php/up-j-mdbcj/article/view/1345
work_keys_str_mv AT pavanthangudu fromtrendelenburgtopertsevolutioninthemanagementofmassivepulmonaryembolism