Pulmonary embolization (PE) carries a high mortality risk if not suspected and treated properly. Systemic embolization is quite common especially in cases of mobile left ventricular (LV) thrombi. We were encountered with a catastrophic case of thromboembolism with simultaneous massive PE and bilateral lower limb ischemia in a patient with biventricular systolic dysfunction and multiple LV thrombi. Tissue plasminogen activator (tPA) was given and the patient’s hemodynamics started to be stable. Unfortunately, he developed left lag, bilateral lower limb dry gangrene and subsequently he passed away despite all trials to resuscitate.