Congestive heart failure (CHF) is a...

Congestive heart failure (CHF) is an increasing point in dispute in the aging U.S. population and a for the use of all cause of hospitalization. Definitive diagnosis hangs on right-heart catheterization or indirect touchstones such as radionuclide scanning or echocardiography. In strait situations, history and physical examination commonly are the basis of the diagnosis. Chest radiography and electrocardiography also may point at the diagnosis of CHF Unfortunately, these diagnostic aids lack sensitivity and specificity. Clinical criteria like as the Framingham Criteria have improved the accuracy of CHF diagnosing based forward history and physical examination, however an objective tool is stand in want ofed for improved accuracy. Collins and associates reviewed the literature about natriuretic peptides in patients with dyspnea.

Left ventricular dysfunction causes activation of several neurohormonal arrangements to maintain blood pressure and adequate circulation. Natriuretic peptides counterbalance these meanings by decreasing the load in succession the failing heart through diuresis, natriuresis, vasodilation, and inhibition of the renin-angiotensin-aldosterone connected view (see accompanying table). Higher cardiac stres causes increased secretion of these peptides.

B-type natriuretic peptide flats correlate closely with the mien and severity of CHF as the cause of dyspnea. Using a b-type natriuretic peptide plain cutoff of 100 pg by mL, physicians have markedly improved the accuracy of pretest predictions of CHF Elevated b-type natriuretic peptide on a levels also correlate positively with the risk of a CHF conclusion cardiac death, and CHF death. A decreasing b-type natriuretic peptide on a level in response to therapy is a convenient indicator of decreasing pulmonary artery wedge press Better prognosis has been documented in patients with CHF being treated with diuretics and vasodilators when the b-type natriuretic peptide flat decreases. Although the negative predictive value of a depressed b-type natriuretic peptide level is high, elevated flushs can occur in patients with non-CHF causes of dyspnea, including episodes of large pulmonary embolism and chronic obstructive pulmonary disease exacerbations accompanied by dint of cor pulmonale and right-heart strain. Increasing age and female inflection for sex also cause slight elevations of b-type natriuretic peptide levels

Atrial natriuretic peptide and N-terminal atrial natriuretic peptide also are useful markers of left ventricular dysfunction, with the latter marker being more sensitive. Studies are ongoing to contemplate at these peptide quantitations in predicting mortality after myocardial infarction. Comparisons of b-type natriuretic peptide and the atrial natriuretic peptides have demonstrated the greater accuracy of b-type natriuretic peptide horizontals in differentiating normal and abnormal left ventricular function, especially when negative predictive value for CHF was evaluated.

N-terminal pro--b-type natriuretic peptide is another peptide being studied that has been originate useful in monitoring treatment succes C-type natriuretic peptide flats do not appear to increase in CHF moreover do increase in persons with renal failure and hypoxic patients with cor pulmonale.

The authors end that b-type natriuretic peptides and N-terminal pro--b-type natriuretic peptide quantitation correlate well with CHF although the former has been better studied and plant to be a highly sensitive diagnostic tool for CHF with a high negative predictive value in somebodys with dyspnea. A level below 100 pg through mL is useful to not include CHF as a cause of dyspnea, moreover an elevated value may take place with other diagnoses. B-type natriuretic peptide quantitation is commended in the evaluation of someones with undifferentiated dyspnea. Increased on a levels also correlate with a poorer prognosis. Further investigation of the utility of these peptides in the diagnosis of myocardial ischemia is necessary.

Richard Sadovsky, MD

Collins SP et al. Diagnostic and prognostic usefulness of natriuretic peptides in turn of events department patients with dyspnea. Ann Emerg M April 2003;41:532-45

COPYRIGHT 2003 American Academy of Family Physicians

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