Despite important advances in the diagnosis and treatment of acute pulmonary embolism (APE), assessment of risk and appropriate management of patients remains a difficult task in clinical practice. In addition to hemodynamic instability and critically clinical condition, acute right ventricular dysfunction (RVD) is a major determinant of in-hospital outcomes. The purpose of this review is to discuss the results of these recent developments. Some outcome evaluation, clinical assessment, and therapeutic implications are also included.