NPPB and obesity due to melanocortin 4 receptor deficiency: The presence of lower BNP values in obese patients and of a linear increase in high sensitivity troponin T level in patients with a BMI > 35 kg/m2 poses a challenge in the accurate interpretation of these biomarkers in patients with acute pulmonary embolism and Grade 3 obesity (BMI ≥ 40 kg/m2) [4,5].