Kristine Khachatryan

Erebuni Medical Center, Armenia

Acute Pulmonary Embolism: Thrombolysis and Outcomes in a High-Risk Patient

Biography

Kristine Khachatryan, MD, is a cardiologist at Erebouni Medical Center in Yerevan, Armenia, and serves as a lecturer at both the National Institute of Health and the “Erebouni” Medical Academy Foundation. She earned her medical degree from Yerevan State Medical University, with a specialization in cardiology and echocardiography.

Khachatryan has been recognized for her exceptional service during the COVID-19 pandemic and has contributed to the field through peer-reviewed research, particularly in heart failure. She is an active member of several professional societies, including the European Society of Cardiology, the European Heart Rhythm Association, the European Association of Cardiovascular Imaging, and the Heart Failure Association.

Her clinical and academic interests focus on acute cardiovascular care, heart failure, and cardiopulmonology.

Abstract

Pulmonary embolism (PE) remains a life-threatening emergency requiring prompt recognition and intervention. We report the case of a 71-year-old male with type 2 diabetes mellitus who presented with hemoptysis, dyspnea, and severe hypoxemia (SaO? 81%). On admission, he was hypotensive (80/60 mmHg), tachycardic (110 bpm), and in respiratory distress. CT pulmonary angiography confirmed bilateral pulmonary emboli with right ventricular dilation, consistent with high-risk PE. According to European Society of Cardiology guidelines, systemic thrombolysis was indicated. Alteplase (100 mg over 2 hours) was administered, leading to rapid hemodynamic stabilization, improved oxygenation (SaO? 92%), and symptom resolution. The patient was transitioned to Rivaroxaban (15 mg twice daily) for long-term anticoagulation. Serial echocardiography and CT angiography demonstrated reduced thrombus burden and improvement in right ventricular function. No bleeding or other complications occurred during hospitalization. At one-month follow-up, the patient remained asymptomatic with stable vital signs and oxygen saturation. This case highlights the critical importance of early diagnosis and guideline-directed therapy in acute PE with hemodynamic compromise. Prompt thrombolysis improved short-term outcomes and, in combination with direct oral anticoagulation, provided effective long-term protection against recurrence. Comprehensive management of comorbidities, including diabetes and atherosclerosis, further reduced cardiovascular risk. Our findings reinforce the value of multidisciplinary care, risk factor modification, and adherence to evidence-based guidelines in optimizing outcomes for patients with high-risk pulmonary embolism.