The elevated troponin and BNP levels also supported the differential diagnosis of right heart strain secondary to PE. PE obstructs the pulmonary arteries, which leads to increased pulmonary vascular resistance and subsequent myocardial shear stress on the right ventricle. This results in acute right ventricular dilatation and myocardial ischemia, which leads to the rise of BNP and troponin respectively [11]. This evidence concerns the gene NPPB and myocardial ischemia.