Background: Massive pulmonary embolism (MPE) is a potentially fatal event that can occur at any age. A possible form of presentation is through a syncope, whereas the appearance of an atrioventricular (AV) block is
exceptional. Although thrombolysis therapy is recognized to be efficacious in pulmonary embolism that courses with shock or cardiorespiratory instability, improving the situation, there has been no report to date of an AV
block from an MPE that disappears after the administration of thrombolysis.
Case report: We describe a 35-year-old woman who developed a high-grade AV block from an MPE that progressed to shock. In the presented case, the AV block and shock symptoms disappeared after the administration
of alteplase.
Conclusions: Pulmonary embolism should be considered in the differential diagnosis of atrioventricular block. Evidently, the prognosis of the block will depend on the evolution of the MPE. Early thrombolytic therapy of the
PE abates shock symptoms and may restore heart rhythm.

Keywords: Pulmonary Embolism, thrombolysis, atrioventricular block, Shock