age. Its prognosis is largely unpredictable, pending the origin of the sudden loss of
consciousness. We report a case of an old woman affected by severe chronic heart
failure, who died soon after the development of an episode of syncope, which was
eventually attributed to pulmonary embolism. Anticoagulant therapy, promptly
instituted, was ineffective. In the differential diagnoses of syncope, pulmonary
embolism should always be considered, especially in old patients with risk factors
for venous thromboembolism such as a severe heart failure. In patients with high
risk of death according to the widely adopted risk stratifications score, aggressive
therapy may be considered also in elderly people to prevent unfavourable
outcomes
