N-Terminal Pro B-Type Natriuretic Peptide(NT-PRO BNP)

Which cardiac conditions can be diagnosed by testing NT-proBNP?

NT-proBNP helps in diagnosing acute heart congestive heart failure, it is typically high in patients with the worst outcome. Plasma levels of NT-proBNP are also raised in symptomatic or asymptomatic left ventricular dysfunction. It is also useful in diagnosing coronary artery disease and myocardial ischemia.

What is heart failure?

Heart failure is the condition when the heart is not able to maintain sufficient blood flow to tissues to meet their requirements for metabolism.

What are the causes of heart failure?

Common causes include coronary artery disease,high blood pressure, valvular dysfunction, previous myocardial infarction, excessive alcohol intake, and cardiomyopathy.

What is a heart attack?

Heart attack is the condition in which part of the heart muscle dies.

Is heart attack different from heart failure?

Heart attack presents suddenly when one of the coronary arteries(arteries supplying blood to the heart) gets blocked, resulting in a cutoff of blood supply and oxygen to the heart muscle due to which heart muscle dies.

Whereas, heart failure occurs gradually. In this condition, the heart muscle gets weaker with time and is unable to pump blood sufficiently to rest parts of the body.
Heart attacks can progress to heart failures as the muscle’s pumping capacity gets weakened.

Sometimes, heart failure can present suddenly following a heart attack, where the symptoms can be severe. This condition is called acute heart failure.
The most common cause for both conditions is coronary artery disease.

What are the signs and symptoms of heart failure and heart attack?

Symptoms of heart attack are:

• Chest pain ( it feels like the centre area of the chest is being squeezed or like heartburn). This is the most common symptom.
• Pain may get transmitted to the upper parts of the body, to the neck, jaw, arms, back and stomach.
• Breathlessness
• Nausea , vomiting or malaise.

Heart failure presents as:

• Shortness of breath( in lying down position most commonly)
• Wheezing or coughing
• Tachycardia or irregular heartbeats
• Tiredness
• Swelling in lower extremities (around ankles, over legs)

What are the investigations done to diagnose heart failure?

An electrocardiogram (ECG), blood investigations and chest radiograph are done to diagnose heart failure.

What are the other blood investigations done to diagnose heart diseases?

a) Blood cholesterol levels: high levels of total and LDL cholesterol and low levels of HDL cholesterol point towards increased chances of atherosclerotic plaques in the arteries.

b) Triglycerides levels: High triglyceride levels indicate that you regularly eat more calories than you burn. High levels indicate high risk for heart failure.

c) High sensitivity CRP( hs CRP) : it is a protein produced by the liver in response to inflammation in the body. Inflammation has a major role in the pathogenesis of atherosclerosis. Hs CRP provides an estimate of risk of developing heart disease before development of symptoms.

d) Lipoprotein (a) : it is a type of LDL cholesterol. High levels correlate with high chances of developing heart diseases.

e) Troponins: troponins are regulatory proteins involved in heart muscle contraction activity. Measurement of cardiac specific troponin I and T are used in diagnosis and ascertaining prognosis in the management of myocardial infarction and acute coronary syndromes.

f) CPK-MB: is used for diagnosing acute myocardial infarction.

g) ST2 cardiac biomarker( also known as soluble interleukin 1 receptor-like 1) is a protein biomarker of cardiac stress. ST2 detects the severity and presence of cardiac remodeling and tissue fibrosis. This occurs as a response to myocardial infarction, acute coronary syndrome or worsening heart failure.

h) Other blood investigations include liver function tests and renal function tests