Echocardiographic detection of right heart strain in a patient who presents with shock: A clue to acute pulmonary embolism

This report describes a 59-year-old male patient with rectal carcinoma who presented with sudden onset of cyanosis and hypotension. The transthoracic and transesophageal echocardiography revealed evidence of right heart strai n and pulmonary hypertension (the estimated systolic pulmonary arterial pre ssure was 49 mm Hg), which led us to suspect the presence of an acute pulmo nary embolism. A subsequent lung perfusion scan confirmed the diagnosis of an acute pulmonary embolism. In conclusion, echocardiography is a useful di agnostic tool in evaluating a patient who presents with unexplained hypoten sion.