A 40-year-old male tobacco chewer presented with complaints of left lower limb pain for 4 days. On examination, he had swelling in his left lower limb and ECG showed signs of right ventricular strain. Echocardiogram revealed an enlarged right ventricle and atrium with moderate tricuspid regurgitation and reduced right ventricular function. Given his risk factors and test results, the patient is at intermediate-low risk for pulmonary embolism. A CTPA was planned to confirm, anticoagulation was started, and oral anticoagulation was recommended for 6 months with follow up in 3 months to assess right ventricular function and risk of chronic thromboembolic pulmonary hypertension.

2.  Admitted with complaints of
 M r shiv kumar 40 yr male ,tobacco chewer.
 DOE since 10 days
 Pain in left lower limb since 4 days
On admission –
Consious oriented , BP 110/70 mmHg, PR 82/min,spo2
95%on room air .
Chest b/l clear ,jvp normal ,s1 s2 n,no murmur .
Swelling present in left ll .
Ecg – RBBB ,T inversion v1 to v6,s1q3t3.
2D echo – RA RV dialted , mod TR (46 +rap),TAPSE 2.1.

3. Review of 2019 ESC Guideline

9. Acute Mangement
 1 Oxygen and hemodynamic support.
 If Spo2 < 90 % nasal prong
 NIV
 In RV failure Avoid intubation.

10. RV failure

13.  Max benefit when started within 48 hr of onset of
symptom.
 Usefull upto 6-14 days .
 Unsuccessful throbolysis judged by
 persistent clinical instablity .
 unchanged RV dysfunction on ECHO after 36 hr
 (reported in 8% high risk PTE

20.  Chronic treatment and prevention of recurrence.

25. Follow up .

30. Back to patient
 Hemodyamic stable .
 Intermediate low risk
 High likely risk of PTE <prediction score 3.
 Plan to do CTPA
 Start anticoagulant .
 Start ORAL ANTICOAGULANT
 Duration 6 month ((11a)
 followup afte 3 month do 2D echo ,functional status
assement ,risk of CTEPAH.