Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism

Clinical Question

In patient’s with intermediate-risk PE does the addition of fibrinolytic therapy to standard anticoagulation therapy improve mortality and/or hemodynamic decompensation in the first 7 days.

Bottom Line

Patient’s with intermediate-risk PE who received fibrinolytic therapy in combination with standard anticoagulation had a statistically significant reduction in hemodynamic instability within 7 days as well as a statistically significant increase in major bleeding events.

The HEART Score

Clinical Question

Can ED patients with nonspecific chest pain concerning for NSTEMI be risk stratified for MACE?


  • Use of the HEART pathway increases early discharge/decreases admission for chest pain by 21% with NPV for MACE >99% versus usual care
  • Use of the HEART pathway decreases further cardiac testing by 12.1% and length of stay by 12 hours
  • Back to those 9750 cases per year at TJUH: adherence to HEART score could save 117,000 hours and $2,106,000

J-Point Elevation in Survivors of Primary Ventricular Fibrillation and Matched Control Subjects

Clinical Questions

  • In patients without structural heart disease, is the presence of J-point elevation a marker for arrhythmic risk?
  • Does the presence of J-point elevation, either with or without ST-segment elevation, in leads other than V1 to V3, exist as an innocent finding, or is this a marker associated with a history of VF in patients without structural heart disease?
  • Is J-point elevation more prevalent in younger individuals?

Bottom Line

Although J-point elevation is found more frequently among patients with idiopathic VF than among healthy controls, its presence should not be interpreted as a marker for increased risk when incidentally detected via screening.