We present a case of a young patient with a history of recurrent venous thromboembolism, stroke status post fibrinolysis, and titin-related dilated cardiomyopathy who developed cardiogenic shock in the setting of decompensated heart failure and concomitant large left ventricular thrombus comprising ∼75% of the cavity. The gene discussed is TTN; the disease is dilated cardiomyopathy.