Introduction: The presentation of evolution of acute pulmonary heart of a patient with deep vein thrombosis Methods: We report the case of a patient aged 44, without significant pathological history, presented with pronounced inspiratory dyspnea in minimal exertion, palpitations, hemoptysis, general weakness, fever, the right leg pain when walking. Disease onset of 4 weeks, when aft er a long travel the right leg increased in size. He hasn’t adressed the doctor. With 6 days before the hospitalization it appeared inspiratory dyspnea at a minimal physical effort. He treated it into the place of residence, but no positive dynamics. The Wells probability score of the pulmonary thromboembolism was 7, D-dimers were positive. Echocardiographic examination determined the presence of acute pulmonary heart: RA-52 mm, RV-36 mm, third degree tricuspid insufficiency, sever pulmonary hypertension (71 mm Hg). Results: Pulmonary angioCT showed thrombotic masses in the pulmonary arteries and their branches, which caused the obstruction or narrowing of their lumens and some areas of infarct-pneumonia in both lungs. Venous Doppler ultrasound detected vascular occlusive thrombotic masses in the deep veins of the right leg. Th erapy with Fondaparinox, Warfarin, calcium channel antagonists (Diltiazem), Euphyllin, antibiotics and oxygen applied for 21 days led to a decrease in size of right parts heart (RA-41 mm, RV-26 mm), reduction of tricuspid insufficiency degree (fi rst degree) and pulmonary artery pressure (32 mm). Venous Doppler ultrasound detected lumen recanalization of right popliteal vein and superficial femoral vein. Conclusions: After three months the dimensions of RA (38 mm) and RV (26 mm) remained normal, with first tricuspid insufficiency degree, without increasing of pulmonary artery pressure, with recanalization of the right femoral superficial vein lumen, popliteal vein and posterior tibialis vein. Keywords: pulmonary artery thrombosis, acute pulmonary heart.