Credits for sharing to Dr. Abdulrahman Nassiri 💐👌🤝 100 concise pearls from the 2026 AHA/ACC Guideline for Acute PE 🫀 Acute PE – 100 Pearls 1️⃣ PE risk stratification is mandatory before therapy. 2️⃣ New AHA/ACC Acute PE Clinical Categories A–E introduced. 3️⃣ Category A = incidental, asymptomatic PE. 4️⃣ Category B = symptomatic, low severity score. 5️⃣ Category C = elevated severity score ± RV strain. 6️⃣ Category D = incipient cardiopulmonary failure. 7️⃣ Category E = cardiopulmonary failure. 8️⃣ Use validated clinical probability tools. 9️⃣ Wells score remains practical. 🔟 Revised Geneva score validated. 1️⃣1️⃣ PERC rule avoids unnecessary imaging in very low-risk. 1️⃣2️⃣ Always assess pretest probability before imaging. 1️⃣3️⃣ Age-adjusted D-dimer recommended. 1️⃣4️⃣ Threshold = age ×10 μg/L (FEU). 1️⃣5️⃣ <2% failure acceptable for PE exclusion. 1️⃣6️⃣ YEARS algorithm reduces imaging burden. 1️⃣7️⃣ D-dimer strategies unsafe if already anticoagulated. 1️⃣8️⃣ Pregnancy-adapted YEARS supported. 1️⃣9️⃣ Avoid over-testing in low probability patients. 2️⃣0️⃣ CTPA is first-line imaging. 2️⃣1️⃣ Positive CTPA confirms PE. 2️⃣2️⃣ High-probability V/Q is diagnostic. 2️⃣3️⃣ Prefer CTPA over planar V/Q. 2️⃣4️⃣ V/Q SPECT better than planar V/Q. 2️⃣5️⃣ Echo cannot rule in or rule out PE. 2️⃣6️⃣ RV/LV ratio should be reported numerically. 2️⃣7️⃣ RV/LV ≥1 suggests RV strain. 2️⃣8️⃣ TAPSE <1.6 cm abnormal. 2️⃣9️⃣ McConnell’s sign indicates RV dysfunction. 3️⃣0️⃣ Report chronic thromboembolic signs on CT. 3️⃣1️⃣ LMWH preferred over UFH initially. 3️⃣2️⃣ DOACs preferred over VKAs. 3️⃣3️⃣ DOACs reduce major bleeding. 3️⃣4️⃣ Extended anticoagulation if unprovoked PE. 3️⃣5️⃣ Treat first episode ≥3–6 months minimum. 3️⃣6️⃣ Persistent risk → continue beyond 6 months. 3️⃣7️⃣ Evaluate bleeding risk regularly. 3️⃣8️⃣ IVC filters not routine. 3️⃣9️⃣ Use IVC filter only if anticoagulation contraindicated. 4️⃣0️⃣ Remove IVC filter when safe. 4️⃣1️⃣ Category A patients can be discharged. 4️⃣2️⃣ Category B often early discharge. 4️⃣3️⃣ Category C requires hospitalization. 4️⃣4️⃣ Category D needs close monitoring. 4️⃣5️⃣ Category E needs aggressive intervention. 4️⃣6️⃣ Persistent hypotension defines high risk. 4️⃣7️⃣ Use biomarkers for risk stratification. 4️⃣8️⃣ Troponin elevation signals myocardial injury. 4️⃣9️⃣ BNP elevation suggests RV strain. 5️⃣0️⃣ PE Response Teams (PERT) recommended. 5️⃣1️⃣ Systemic thrombolysis for high-risk PE. 5️⃣2️⃣ Consider advanced therapy in D1–D2. 5️⃣3️⃣ Catheter-directed thrombolysis reasonable. 5️⃣4️⃣ Mechanical thrombectomy evolving option. 5️⃣5️⃣ Surgical embolectomy when indicated. 5️⃣6️⃣ ECMO for refractory shock. 5️⃣7️⃣ Avoid routine thrombolysis in low-risk PE. 5️⃣8️⃣ Evaluate for contraindications before lytics. 5️⃣9️⃣ Monitor for intracranial hemorrhage risk. 6️⃣0️⃣ Early recognition saves mortality. 6️⃣1️⃣ Assess hemodynamics continuously. 6️⃣2️⃣ Monitor oxygenation closely. 6️⃣3️⃣ HFNC or NIV may be required. 6️⃣4️⃣ Mechanical ventilation cautiously. 6️⃣5️⃣ Avoid aggressive fluid overload. 6️⃣6️⃣ Use vasopressors if hypotension. 6️⃣7️⃣ Norepinephrine preferred. 6️⃣8️⃣ Reassess category over time. 6️⃣9️⃣ Clinical status can evolve rapidly. 7️⃣0️⃣ Repeat imaging only if clinically indicated. 7️⃣1️⃣ Ask about dyspnea at every follow-up visit. 7️⃣2️⃣ Screen for CTEPD at least 1 year. 7️⃣3️⃣ Persistent symptoms need evaluation. 7️⃣4️⃣ Chronic RV strain needs specialist input. 7️⃣5️⃣ Exercise intolerance must be addressed. 7️⃣6️⃣ Educate patients about recurrence risk. 7️⃣7️⃣ Travel guidance important. 7️⃣8️⃣ Activity resumption individualized. 7️⃣9️⃣ Avoid routine thrombophilia testing acutely. 8️⃣0️⃣ APS alters anticoagulation choice. 8️⃣1️⃣ Cancer-associated PE requires special planning. 8️⃣2️⃣ Pregnancy PE requires low-dose protocols. 8️⃣3️⃣ Avoid over-radiation in pregnancy. 8️⃣4️⃣ Avoid under-treatment of high-risk PE. 8️⃣5️⃣ Document RV strain in report. 8️⃣6️⃣ Quantify clot burden cautiously. 8️⃣7️⃣ Clot burden alone not treatment determinant. 8️⃣8️⃣ Clinical severity score essential. 8️⃣9️⃣ Hemodynamics trump imaging. 9️⃣0️⃣ Biomarkers add prognostic