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Acute pulmonary embolus with visible right heart thrombus in transit
  1. Michael Thomas Debney
  1. Cardiology Department, Imperial College NHS Healthcare Trust, London, UK
  1. Correspondence to Dr Michael Thomas Debney, mikedebney{at}googlemail.com

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A 29-year-old woman presented to our emergency department with syncope, acute chest pain and circulatory collapse. She had a tachycardia of 135 bpm, blood pressure of 77/55 mm Hg and a profound metabolic acidosis (pH 7.07, lactate 10, base excess-20). A 12-lead ECG (figure 1) showed sinus tachycardia with right axis deviation, large p waves and poor R wave progression across the chest leads, suggestive of acute right heart strain. …

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