Bradyarrhythmia in acute massive pulmonary embolism

Pulmonary embolism (PE) can present with a variety of electrocardiographic findings. Bradycardia is rare finding in acute PE, which typically manifests sinus tachycardia. PE might arise from the physiologic Bezold–Jarisch reflex, describes constellation bradycardia, peripheral vasodilation, and hypotension. We report case woman her 60s who was admitted initially for submassive found to have bradycardia. She had progressed massive worsening atrioventricular conduction block setting atrial flutter. Her bradyarrhythmia resolved hemodynamics improved after catheter directed thrombolysis. This revisits pathophysiology importance recognizing that it signifies an underlying pathologic insult, especially life-threatening one like PE.