Risk stratification in patients with acute pulmonary embolism (PE) is essential to guide the choice of appropriate therapy. The stratification of risk is first and foremost based on the presence of signs of hemodynamic instability, which is associated with a very high risk of early death, but affects only around 5% of PE patients. For the vast majority of normotensive PE patients, it is recommended to proceed with imaging, mainly to investigate the presence of right ventricular (RV) dysfunction, and laboratory indicators of PE severity (mostly deriving from the presence of RV dysfunction).