Jon-Emile S. Kenny MD [@heart_lung] Commonly, we are sold that acute pulmonary thromboembolism [PE] burns the right ventricular [RV] candle at both ends. This is because perfusion of the right coronary artery [RCA] is mediated by both its upstream mean arterial pressure [MAP] and downstream right ventricular end-diastolic pressure [RVEDP]. Given that a PE may decrease the former and increase the latter, perfusion of the RCA is particularly precarious in the face of an acute, substantial RV outflow obstruction. Additionally, unlike the left coronary artery, the RCA is perfused during both systole and diastole; as a consequence, high RV cavity pressure can especially impair normal RCA systolic perfusion [1] likely by congesting the Thebesian vessels [2].