Pulmonary embolism becomes immediately life-threatening when the right ventricle fails.
The right ventricle is built for volume, not pressure.
Under normal conditions, it ejects blood into a low-resistance pulmonary circulation. Acute pulmonary embolism abruptly increases pulmonary vascular resistance, forcing the right ventricle to generate pressures it was never designed to tolerate.
This is the central physiology of massive PE.
As RV afterload rises, the right ventricle dilates.
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