Thrombolytic treatment is indicated (recommendation IIB) in selected patients with sub-massive PE/intermediate risk who have evidence of RHD echocardiographically and by biomarkers (BNP or NTproBNP), myocardial damage shown by increased levels of troponin I or T [5, 6] and not absolute contraindications to thrombolysis (Table 3). Here, NPPB is linked to rheumatic heart disease.