Patients with acute pulmonary embolism (PE) characterized by hemodynamic stability, evidence of right ventricular (RV) dysfunction (RVD), positive cardiac biomarkers and high simplified pulmonary embolism score index (sPESI) are classified as intermediate-high risk or submassive PE, according to the current European or American guidelines, respectively [1,2]. Up to 10 % of these patients may suddenly experience hemodynamic deterioration or fail to show signs of improvement within the first few hours after symptom onset [3].
