What's Your Diagnosis? Right Heart Failure in the ED

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on A Practice-Based Approach to Emergency Department Evaluation and Management of Patients With Postacute Sequelae after COVID-19 Infection: Long COVID correct.

Case Presentation: Emergency Department Management of Patients With Right Heart Failure

A 40-year-old woman presents with dyspnea, tachycardia, and hemoptysis…

Her vital signs are: temperature, 36.9°C; heart rate, 125 beats/min; blood pressure, 120/65 mm Hg; respiratory rate, 24 breaths/min; and oxygen saturation, 94%.
She takes estrogen-containing medications, and reports that she recently had a cross-continental airplane flight.
As you place initial orders, you consider whether transthoracic echocardiography would aid in her evaluation and management…

Case Conclusion

After CT confirmation of a diagnosis of pulmonary embolism, you performed a bedside TTE and diagnosed RVD based on an increased RV/LV ratio. You recognized the need for hospital admission due to her high risk for hemodynamic collapse, and you consulted your hospital pulmonary embolism response team for the consideration of advanced therapies.