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Pulmonary embolism increases right ventricular afterload, which causes right ventricular failure, circulatory collapse and death. Most treatments focus on removal of the mechanical obstruction caused by the embolism, but pulmonary vasoconstriction is a significant contributor to the increased right ventricular afterload and is often left untreated. Pulmonary thromboembolism causes mechanical obstruction of the pulmonary vasculature coupled with a complex interaction between humoral factors from the activated platelets, endothelial effects, reflexes and hypoxia to cause pulmonary vasoconstriction that worsens right ventricular afterload. Vasoconstrictors include serotonin, thromboxane, prostaglandins and endothelins, counterbalanced by vasodilators such as nitric oxide and prostacyclins. Exogenous administration of pulmonary vasodilators in acute pulmonary embolism seems attractive but all come with a risk of systemic vasodilation or worsening of pulmonary ventilation\u2010perfusion mismatch. In animal models of acute pulmonary embolism, modulators of the nitric oxide\u2010cyclic guanosine monophosphate\u2010protein kinase G pathway, endothelin pathway and prostaglandin pathway have been investigated. But only a small number of clinical case reports and prospective clinical trials exist. The aim of this review is to give an overview of the causes of pulmonary embolism\u2010induced pulmonary vasoconstriction and of experimental and human investigations of pulmonary vasodilation in acute pulmonary embolism.<\/jats:p>","DOI":"10.1177\/2045894019899775","type":"journal-article","created":{"date-parts":[[2019,12,20]],"date-time":"2019-12-20T11:24:01Z","timestamp":1576841041000},"page":"1-16","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":83,"title":["Pulmonary vasodilation in acute pulmonary embolism \u2013 a systematic review"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5279-260X","authenticated-orcid":false,"given":"Mads Dam","family":"Lyhne","sequence":"first","affiliation":[{"name":"Department of Cardiology Aarhus University Hospital and Institute of Clinical Medicine Aarhus University Aarhus 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