Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 2 2024 11 06 74 78 Iman Bhia Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Aryan Seraj Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Toktam Alirezaei Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 09 15 2024 10 19 The rising use of herbal medicines raises concerns about their safety and effectiveness. This case report involves a 55-year-old male who developed shortness of breath and chest discomfort after using herbal substances and sildenafil for erectile dysfunction and infertility. He was diagnosed with a massive acute pulmonary embolism (PE) via CT angiography and treated with alteplase, followed by oral apixaban after discharge. The herbal substances included carob, ginger, red ginseng, and others. This case highlights the need to investigate how herbal remedies may affect hormone balance and contribute to cardiovascular risks, particularly PE.  https://crcp.tums.ac.ir/index.php/crcp/article/view/986 https://crcp.tums.ac.ir/index.php/crcp/article/download/986/660