The occurrence of multiple biventricular thrombi in patients with dilated cardiomyopathy is extremely rare. A 47-year-old man with a history of 25 years of cocaine and amphetamine use presented with recent onset of weakness, palpitations, persistent dry cough and shortness of breath on minimal exertion. At admission, physical examination revealed sinus tachycardia with pulse 100/min, blood pressure 94/64 mm Hg, elevated jugular venous pressure, bilateral basal rales, S3 gallop, 2/6 midsystolic murmur at the apex, and mild hepatomegaly. Relevant laboratory tests were normal (including troponin I) except …