**Core Concept**
Acute pulmonary embolism (PE) with right ventricular (RV) dysfunction and compromised cardiac output poses a significant clinical challenge. The primary goal is to restore RV function, improve cardiac output, and prevent further complications.

**Why the Correct Answer is Right**
In this scenario, the treatment of choice is **thrombolytic therapy**. Thrombolytics, such as tissue plasminogen activator (tPA), work by activating plasminogen to plasmin, which then degrades fibrin clots, thereby restoring blood flow and improving RV function. The use of thrombolytics in PE with RV dysfunction is supported by guidelines and has been shown to improve outcomes in this high-risk subgroup. The presence of normal blood pressure in this patient suggests that the RV dysfunction is not yet severe enough to cause significant hypotension, making thrombolytic therapy a more appropriate option.

**Why Each Wrong Option is Incorrect**
**Option A:** **Surgical embolectomy** is typically reserved for patients with massive PE causing severe hypotension or cardiac arrest, which is not the case in this scenario. Additionally, surgical embolectomy carries significant risks and is generally not preferred over thrombolytic therapy.

**Option B:** **Anticoagulation** alone is insufficient in this scenario, as the patient requires more aggressive treatment to restore RV function and improve cardiac output. Anticoagulation is essential for preventing further clot formation but will not dissolve existing clots.

**Option C:** **Supportive care** may be appropriate for patients with stable PE, but in this scenario, the patient has compromised cardiac output and RV hypokinesia, requiring more active intervention to prevent further deterioration.

**Clinical Pearl / High-Yield Fact**
In patients with acute PE and RV dysfunction, the presence of normal blood pressure does not rule out the need for thrombolytic therapy. In fact, guidelines recommend thrombolytic therapy in this subgroup to improve outcomes.

**Correct Answer:** A. Thrombolytic therapy