A floating thrombus of the right ventricle in severe massive pulmonary embolism.

Floating right heart thrombus (FRHT) is a severe presentation of thromboembolic disease and usually coexists with massive pulmonary embolism. Patients with FRHT are more hemodynamically compromised and usually have a higher mortality rate than patients without FRHT. An echocardiographic finding of FRHT is important because it identifies as poor prognosis. The optimal treatment in patients with FRHT remains uncertain. Heparin is more often an anticoagulant than a lytic agent. Several studies suggested that thrombolytic therapy has advantages in treating such patients. Early diagnosis and emergency therapy are important in treating patients with FRHT in the emergency department and they might have fatal outcomes when treated only with heparin.