BACKGROUND Sildenafil is a pulmonary vasodilator and its efficacy has been well established in patients with group 1 pulmonary hypertension. There are no established guidelines regarding its use in acute right ventricle failure. In our experience, it can be used as an adjunctive therapy in acute right ventricle failure due to pulmonary embolism, to reduce right ventricle afterload and hence improve size and function of the right ventricle. CASE REPORT This is a case report where sildenafil was used as a rescue agent to achieve improvement in the right ventricle size and function in a case of acute onset massive pulmonary embolism with acute right ventricle failure in the scenario where systemic thrombolytic therapy was contraindicated. CONCLUSIONS Improvement of right ventricle size and function was achieved using phosphodiesterase-5 Inhibitors in a case of acute right ventricle failure due to acute massive pulmonary embolism. There are no established guidelines regarding this clinical approach, however, given its efficacy in this case as adjunctive therapy in treatment of acute right ventricle, larger studies are needed to further establish its utility.