A submassive pulmonary embolism refers to an acute pulmonary embolism with evidence of myocardial necrosis or right ventricular dysfunction in the absence of systemic hypotension. An elevation in troponin I or T provides evidence of myocardial necrosis. Right ventricular dysfunction is defined by the presence of any of the following:
- echocardiographic evidence of right ventricular dilation or systolic dysfunction
- an RV/LV diameter ratio >0.9 on CT 4
- biomarker elevations
- brain natriuretic peptide (BNP) > 90 pg/mL or pro-BNP >500 pg/mL
- characteristic electrocardiographic abnormalities
- right bundle branch block (complete or incomplete)
- anteroseptal ST segment deviation
- anteroseptal T wave inversion
Differential diagnosis
-
massive pulmonary embolism
- associated with sustained hypotension, bradycardia with signs of shock, or pulselesness
- right ventricular myocardial infarction
- acute cor pulmonale
- decompensated chronic pulmonary hypertension
- most commonly due to left sided heart disease
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