Sudden Dyspnea in Medicine / Internal Medicine — 78yo Man | Cardiology | SMLE Q#909

SMLE Question #909

Medicine / Internal Medicine Cardiology
Last updated: February 2026
A 78-year-old man with prior ischemic stroke and chronic right-sided hemiparesis presents with sudden dyspnea and pleuritic chest pain. He has had a productive cough for 1 day. CT pulmonary angiography shows a large pulmonary embolus with right ventricular dilatation. Despite supplemental oxygen and IV fluids, he remains hypotensive with signs of shock. What is the most appropriate next step in management?

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