Fast Five Quiz: Heart Failure Presentation and Diagnosis

Yasmine S. Ali, MD


December 02, 2021

BNP is the strongest predictor of heart failure vs other causes of dyspnea. High LV filling pressures stimulate the release of BNP, which exerts diuretic, natriuretic, and antihypertensive effects by inhibiting the renin-angiotensin-aldosterone system. BNP also has systemic and renal sympathetic activity and may provide a protective effect against the detrimental fibrosis and remodeling that occurs in progressive heart failure. An elevated BNP level is a marker of increased LV filling pressures and LV dysfunction.

Although BNP is the strongest predictor of systolic vs nonsystolic heart failure, it does not reliably differentiate whether the ejection fraction (EF) is preserved or not. The N-terminal proBNP marker elevations differentiate heart failure accompanied by reduced EFs.

Elevated blood urea nitrogen-to-creatinine ratio, hypernatremia, and hyperkalemia, and decreased aspartate aminotransferase, alanine aminotransferase, and lactic dehydrogenase do not necessarily occur with heart failure, and therefore are not predictors of heart failure vs other causes of dyspnea.

Learn more about the role of natriuretic peptides as predictors of heart failure.


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