Timeline	Description
Day 0	A 64-year-old male patient presented to the emergency room following sudden loss of consciousness.
Day 0–10 min after admission	Initial electrocardiogram showed sinus rhythm, incomplete right bundle branch block and S1Q3T3 pattern
Day 0–15 min after admission	Initial echocardiogram revealed non-dilated right ventricle with reduced right ventricular systolic function with right and left atrial thombi protruding through A-V valves. Probable diagnosis was made: intermediate-high-risk (submassive) pulmonary embolism with a Thrombus in transit
Day 0–30 min after admission	A triple rule-out protocol computed tomography angiography revealed multiple filling defects involving subsegmental branches of right and left pulmonary arteries
Day 0–2 h after admission	Urgent transoesophageal echocardiography confirmed the diagnosis of thrombus in transit across patent foramen ovale. Initial anticoagulation with low molecular weight heparin was initiated.
Day 0–8 h after admission	Patient underwent surgical thrombectomy with removal of thrombus from patent foramen ovale as well as small thrombus in both right and left main pulmonary arteries.
Day 0–14 h after admission	Patient enters post-surgical therapy intubated with inotropic and vasopressor support.
Day 1	Optimization of fluid therapy and removal of vasopressor and inotropic support, weaning and removal of mechanical ventilation.
Day 2	Respiratory therapy is started with incentive inspirometer.
Day 3	Removal of mediastinal tubes with subsequent mobilization. Oral anticoagulation with rivaroxaban 15 mg b.i.d. is started.
Day 6	Patient is discharged from post-surgical therapy to hospitalization. Post-surgical control echocardiogram is performed.
Day 8	Phase 1 of cardiac rehabilitation begins
Day 12	Coagulopathy workup is started.
Day 14	Patient is evaluated by pulmonary hypertension clinic without further changes in treatment. Patient undergoes abdomino-pelvic computed tomography scan without finding evidence of cancer with a normal coagulation panel.
Day 18	Patient is given a control appointment for phase 2 of cardiac rehabilitation. Patient is classified as provoked pulmonary thromboembolism do to antecedent of significant immobility (spends a substantial proportion of the day in bed or in a chair).
Day 20	Hospital discharge.