Acute pulmonary embolism (PE) is a life-threatening condition, requiring immediate management. This case report summarises the evaluation and management of a patient who presented with a saddle pulmonary embolus. Since the patient had features suggestive of significant right heart dysfunction, he was thrombolysed with streptokinase but developed cardiogenic shock while on the streptokinase infusion. Therefore, catheter fragmentation and thrombectomy was performed with a view to break and remove the clot. Despite this, his condition deteriorated and unfortunately he died in the ICU. The thrombophilia screen sent before death showed significantly elevated serum levels of homocysteine, which could potentially have caused a hypercoagulable state. This case re-emphasises the mortality associated with major PE and the need for a detailed thrombophilia screen in patients with deep vein thrombosis or PE without any major clinical risk factors.
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