In fatal pulmonary embolism, which pathophysiologic event is most characteristic?

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In fatal pulmonary embolism the hallmark event is acute right ventricular failure from a sudden jump in afterload. An embolus lodges in the pulmonary arteries, dramatically increasing pulmonary vascular resistance. The right ventricle, built for low-pressure circulation, must pump against this much higher pressure and rapidly dilates. That dilation raises wall stress and can outstrip the RV’s blood supply, causing ischemia and further decrease in function. As the right ventricle fails, filling of the left ventricle drops, reducing left-sided cardiac output and leading to systemic hypotension and shock. So death in many fatal cases stems from abrupt right heart failure and ensuing hemodynamic collapse, not from left-sided failure or other conditions. The other choices describe different pathologies that are not the typical mechanism of fatal PE.