We present a case of 72 year old patient who presented with chest pain, shortness of breath (sob) for 2 days and 3 episodes of collapses with loss of consciousness (LOC). His past medical history includes Prostate carcinoma, hypercholesterolaemia and he had AstraZeneca covid vaccines 6 months ago. He was haemodynamically stable and had urgent Computerized Tomography Pulmonary Angiography (CTPA), confirming bilateral pulmonary embolism with evidence of right heart strain. His clinical examination was unremarkable apart from dyspnoea. He was commenced on twice daily treatment dose Clexane and was not thrombolysed in view of haemodynamic stability. He had urgent bedside echocardiogram confirming right ventricular thrombus with associated right heart strain, with no evidence of Patent Foramen Ovale (PFO). Electrocardiogram (ECG) showed right bundle branch block (RBBB) and left axis deviation (LAD). He was discharged home after three weeks on Rivaroxaban 15 mg BD for 21 days followed by 20 mg OD.
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