Bnp

I was wondering the same thing. I was looking it up in my lab book today because a patient of mine had high results and it says "...The BNP test is rarely done because patient history, physical assessments, and other commonly performed tests are usually adequate for making the appropriate diagnosis"

From my experience (which is still limited), checking the BNP is a good way of determining the level of exacerbation the patient is experiencing. Most of our CHFers come in and it is done on admit, we then will monitor to see if therapy is having the desired effect. There is also the use of it to rule-out other causes of dyspnea. While I'm not saying that it should be done by the local 'round the corner doc, from what I've seen, it is useful in acute exacerbations of CHF.

My 2 bits...
Tom

Before we had the BNP, if patients came in SOB there were many pathways you could follow. Lots of patients who had pnuemonia and COPD ended up undertreated because they also had an underlying CHF that didn't always show up as clearly.

The level is a good indicator of severity vs. ejection fraction readings. I've seen people who are clinically stable with an EF of 20% and then people in full blown CHF who have an echo of 40%.

Well generally we are ordering lab tests anyway for these dyspneic people when they come in, so why not throw in a BNP? The benefit of knowing that value outweighs the negatives of ordering it.

It is a very objective test and the more objective data we have on a patient at the start, the more a pin-point diagnosis can be made.

I guesss I have been seeing it too many times in pt.s in whom the diagnosis was pretty clear via H&P and wanted to know if I was missing something in re: treatment modalities.



Since the BNP corrolates with the different NYC classifications, could the docs use them to gauge how hard to push the patients or limit their activity or modify drug treatment? I honestly don't know the answer. However, I do know that unnecessary tests are ordered all the time (ex: continuing serial cardiac enzymes when the troponin is already over 50, ESRs on post op patients - do you think they might be having some inflammation?, rotovirus on every kid that craps, manual diffs on every patient for Dr. X... you get my point)

LifeLONGstudent

BNP is a very unpredictable misunderstood indicator for CHF. A lot of issues can affect come into play when dealing with a CHF patient that can be missed, when trying to use BNP as a diagnostic test. First thing you must consider is that if a patient has renal insufficiency, they will have an elevated BNP as a baseline, therefore when they present to the ER with SOB and a BNP of 900, is it really elevated, or is it actually near their baseline. A BNP is related to LV strain and is NOT going to be elevated in a pt. with a pt. in RIGHT SIDED FAILURE. BNP is a natural vasodilator that works specifically well in the pulmonary vasculature, reducing pulmonary wedge pressure, helping relieve pulmonary edema. Unfortunately, there is not a really good way for a family practitioner to determine the difference between Pneumonia and CHF in many cases other than a BNP, and if the pt. has normal renal function, then the issue is pretty easy to determine, but if the patient has a touch of renal insufficiency, then all bets are out, except in the cases when the BNP is in the >2000 level.

I work on a cardiac floor that specializes in CHF. After attending a class on CHF taught by one of the cardiologists that is director of our heart failure clinic, I have learned that it tends to be more of a tool to measure heart failure over a length of time. For example in an office setting, having it checked every so often. An increase would tend to show worsening. Maybe even could work as an indicator for preventative medicine. However, he also said that medicare is becoming resilient on paying for it. I certainly haven't been seeing it ordered as much anymore. Typically though it is more indicative of left sided heart failure

An old person with pneumonia can that elevates their BNP. Possibly they're in a little HF from the pneumonia but after getting treated, they are totally fine.