The right ventricle physiologically pumps blood to the pulmonary circuit of low resistance. In emergency medicine, we often need to distinguish between acute and chronic right ventricular overload.
Acute overload may indicate acute pulmonary embolism. On the other hand, many causes of chronic overload are known. Thus, during the diagnostic procedure of acute pulmonary embolism, it is necessary to determine if the right ventricular overload is acute or whether we are just witnessing the right ventricle suffering from chronic overload (which in some cases may be worsened by acute pulmonary embolism).
Severe acute pulmonary embolism is highly probable only if clinical symptoms are accompanied by the finding of acute right ventricular overload without signs of chronic overload.
In the following case, we will discuss the right ventricular overload, and at the end, we will determine whether it is acute or chronic one: