Critical Care and Shock

Successful treatment of a massive pulmonary embolism using alteplase in a patient taking antipsychotic drugs

An increased risk of pulmonary embolism (PE) has been reported in female patients taking antipsychotic drugs. Furthermore, patients who take antipsychotic drugs are likely to present with malaise; therefore, the onset of PE is easily overlooked and often discovered by necropsy following PE-related sudden death. (1)

A 73-year-old woman was admitted to the emergency room because of severe shortness of breath and a rapid heartbeat, which had started 2 h earlier. Her medical history included severe depression that had left her bedridden for roughly 3 years. During that period, she frequently tired easily; however, her neighbors believed this to be a result of her depression and, therefore, were not concerned. On her arrival to the emergency room, the clinical examination confirmed hypotension (91/40 mmHg), tachycardia (109 bpm), and a peripheral oxygen saturation in room air of 80%. Examination of the cervix and chest revealed jugular venous distension. She had bilateral pitting edema of the lower extremities. On auscultation of the lungs, bilateral coarse crackles were audible.