Emerging biochemistry tests 1: heart failure

Question 1

What is heart failure? What are the three types? Is it chronic or acute? And is it common?

Answer 1

Heart failure is the inability of the heart to generate sufficient blood flow, the types are systolic/diastolic/right or left sided and it is a chronic condition but can have acute decomposition. It is relatively common affecting 1% of the general pop.

Question 2

What does heart failure lead to?

Answer 2

poor quality of life as it is debilitating and death, the condition has poor survival rates. It also leads to an economic burden due to emergency admissions, readmissions and bed occupancy.

Question 3

What are the 3 signs of heart failure? Are they specific?

Answer 3

1) lung crackles 2) oedema 3)raised jugular ventricular pressure NON-SPECIFIC AND CAN VARY DEPENDING ON THE TYPE OF HF

Question 4

What are the 2 symptoms of HF? Specific?

Answer 4

1)shortness of breath 2)tiredness/weakness NON SPEC AND CAN VARY DEPENDING ON THE TYPE OF HF

Question 5

What are the stages of acute coronary syndrome? 4

Answer 5

1)asymptomatic disease 2)stable angina 3)unstable angina 4)myocardial infarction

Question 6

What percentage of post-AMI survivors go on to aquire CHF?

Answer 6

over 50

Question 7

What 5 other things can lead to CHF?

Answer 7

Hypertension, Valvular disease, cardiomyopathy, infection or other stress

Question 8

Heart failure diagnosis?

Answer 8

difficult, symptoms are non specific. But chest x ray and ECG.

Question 9

What is 2D doppler echocardiography?

Answer 9

it is required for definitive diagnosis of HF AND can determine the type

Question 10

What is B-type natriuretic peptide? (BNP)

Answer 10

a rule out test used to triage patients for echo, cannot diagnose or distinguish HF

Question 11

What are natriuretic peptides?

Answer 11

cardiac hormones with diuretic, natriuretic and vasorelaxant properties that are secreted by the heart in response to ventricular expansion or pressure overload.

Question 12

What is the function of BNPs?

Answer 12

racism HAHA jokes to reduce blood volume and peripheral resistance through vasodilation and natriuresis which is salt excretion.

Question 13

how is BNP synthesised?

Answer 13

in bursts directly proportional to ventricular expansion and pressure overload

Question 14

What is the clinical utility of BNP in HF

Answer 14

to only treat whites HAHA jokes again to aid diagnosis and for prognosis and severity, high BNP = worse prognosis.

Question 15

In the local pathway for chronic HF, if a patient with clinical symptoms of HF HAS had a previous MI, what next?

Answer 15

refer to a breathlessness clinic within a week for an echocardiogram

Question 16

In the local pathway for chronic HF, if a patient with clinical symptoms of HF HAS NOT had a previous MI, what next?

Answer 16

Measure BNP

Question 17

In the local pathway for chronic HF, if a patient with clinical symptoms of HF HAS NOT had a previous MI, and has a BNP level of >400ng/l what next?

Answer 17

same as yes for previous MI

Question 18

In the local pathway for chronic HF, if a patient with clinical symptoms of HF HAS NOT had a previous MI, and has a BNP level of 100-400ng/l what next?

Answer 18

breathlessness clinic for echo within 6 weeks

Question 19

In the local pathway for chronic HF, if a patient with clinical symptoms of HF HAS NOT had a previous MI, and has a BNP level of <100ng/l what next?

Answer 19

Explore alternative diagnosis

Question 20

What changes for acute HF?

Answer 20

> 400 then HF likely so admit to HF unit and book inpateint echo. 100-400 HF possible so refer to outpatient clinic within 72 hrs. <100 still alternative diagnosis

Question 21

BNP assay systems?

Answer 21

Samples from heart failure clinic patients, analysed in duplicate, precision studes and comparison wth POCT device

Question 22

What are 5 points to be aware of when implementing BNP assay systems?

Answer 22

1)analytical considerations - it is a robust/reliable asay 2)costs -kits/labour/QC materials and funding from cardiology 3) testing protocols - agreed turnaround times 4) interpretation - NICE referral guidence 5) regular audit of process

Question 23

What are 4 key benefits to patients of BNP?

Answer 23

1)Quicker, more accurate diagnosis 2)more timely and appropriate treatment 3)less time in hospital 4)greater convenience

Question 24

What are 4 key benefits financially of BNP?

Answer 24

more whites working HAHA JOKES GOD 1)fewer echocardiography referrels 2)fewer outpatient consultant appointments 3)fewer hospital admissions 4)shorter hospital stays

Question 25

What are the three limitations of BNP testing?

Answer 25

1)cannot determine type of HF 2)levels can be reduces by obesity and medication 3)high levels can have a shitton of causes other than HF