A 47-year-old woman with a remote history of hormone receptor positive breast cancer presented to our hospital with dyspnea and malaise. She was hypotensive and had an S3 gallop with cool extremities. Electrocardiogram demonstrated atrioventricular dissociation with a wide underlying ventricular escape. Transthoracic echocardiography revealed a left ventricular ejection fraction of 15% and severely depressed right ventricular function with normal biventricular dimensions.She emergently went for temporary transvenous pacemaker placement and a right heart catheterization with endomyocardial biopsy. This revealed elevated biventricular filling pressures (central venous pressure = 16 mmHg; pulmonary capillary wedge pressure = 19 mmHg) and a low cardiac index (2.0 L/min/kg 2 ).Her hemodynamics deteriorated despite inotropes and an intra-aortic balloon pump, prompting escalation to veno-arterial extracorporeal membrane oxygenation. She was initiated on pulse dose steroids for 3 days, followed by a slow taper. Over the course of 24 hours, she had worsening right ventricular function and developed episodic ventricular tachyarrhythmias requiring recurrent defibrillation. She was escalated to CentriMag biventricular support. The endomyocardial biopsy revealed severe giant cell myocarditis with >25% destruction of the sampled myocardium. After an expedited transplant committee review, the patient was listed for heart transplantation (HT).Three days after HT listing, she developed acute hypoxemia and profound hypotension. CT angiography of the chest identified multiple pulmonary emboli (PE), including a centrally located thrombus causing partial obstruction of the right pulmonary artery. Despite this complication, the patient proceeded to a combined pulmonary embolectomy and HT. She was discharged home from the hospital post HT and at 10-week follow-up demonstrated excellent functional rehabilitation.Although PE is a relative contraindication for heart transplantation, the reversible nature of her pathology and the benefit of avoiding time-dependent pulmonary vascular remodeling favored early transplantation. PE in HT recipients is far less well characterized and has important implications for management and prognosis.