Which of the following is a common complication of a submassive pulmonary embolism?

• A. Left ventricular high-output failure
• B. Left atrial hypoperfusion
• C. Right ventricular strain
• D. Sympathetic crashing pulmonary edema

Answer: (C)

Submassive pulmonary embolism commonly causes right ventricular strain because the emboli raise the pulmonary vascular resistance, forcing the right ventricle to work harder to push blood through the lungs. The thin-walled RV dilates and its function becomes impaired as it strives to maintain forward flow. This strain can reduce left ventricular preload, lower cardiac output, and may progress to right-sided heart failure even if blood pressure stays normal. You may see signs of RV dysfunction on imaging or elevated cardiac biomarkers in this scenario.

The other possibilities aren’t typical manifestations of submassive PE. LV high-output failure isn’t the pattern here, since the problem centers on the right heart under increased afterload, not excessive LV output. Left atrial hypoperfusion isn’t a classic description of this process. Sympathetic crashing pulmonary edema is more tied to abrupt LV failure with a surge of sympathetic activity, not the primary issue in submassive PE.