Case report. Acute cor pulmonale due to massive pulmonary embolism and successful response to thrombolytic therapy.

The proper place of thrombolytic agents in the management of pulmonary embolism is not yet well defined. A number of survivors of acute massive pulmonary thromboembolism remain in a delicate balance of hemodynamic compensation and where recurrent emboli could frequently be fatal. Successful response to urokinase therapy in such a case is presented and the status of currently available thrombolytic drugs is discussed. We suggest that thrombolytic therapy in massive pulmonary embolism would provide greater hemodynamic reserve, alleviate shock, minimize the chances of recurrent emboli and prevent permanent impairment to the pulmonary vascular bed.