Heart failure and BNP Flashcards
BNP physiological mechanism
- REDUCE SYSTEMIC VASCULAR RESISTANCE THEREBY REDUCE AFTERLOAD
- ACT VIA ANP RECEPTORS SO EFFECTS ARE THE SAME AS ANP - Renal : dilates the afferent glomerular arterioles and constricts efferent glomerular arterioles increasing GFR
- inhibits renin secretion by RAAS - Adrenal - reduces aldosterone secretion by zona glomerulosa of adrenal cortex
- relaxes vascular smooth muscles - systemic vasodilation
BNP DEFINITION
1, Brain natriuretic peptide is a hormone secreted by cardio myocytes in the heart ventricles in response to stretching caused by increased ventricular volume
ANP
- synthesized and secreted by atria in response to increased blood volume
- both ANP and BNP act via ANP receptors so same effect on the body
BNP vs NT-proBNP
proBNP is cleaved to form:
- BNP
- biologically active
- 20 min half life
- labile
- higher in healthy females - NT-proBNP
- 60 - 120 min half life
- stable
- increases with age
Factors that increase BNP/NT-proBNP
- tachycardia / ischameia / acute coronar syndrome
- liver cirrhosis
- renal impairment
- Sepsis
- COPD
- Exercise
Factors that decrease BNP/NT-proBNP
- Obesity
- Ace inhibitors
- Angiotensin receptor blockers
- Aldosterone antagonists
- Diuretics
BNP values normal and raised
normal < 100 ng/L
raised > 100 ng/L
NT-proBNP values normal and raised
normal < 300 ng/L
raised > 300 ng/L
definition of heart failure
- Heart failure is when the heart is unable to supply blood to meet the body’s demand
two major types of heart failure are;
- Systolic heart failure - the heart can’t pump hard enough to meet the body’s demands
- Diastolic heart failure - not enough blood fills into the heart
definition of cardiac output
the volume of blood ejected per minute
2. CO = beats per minute x volume of blood per beat
definition of ejection fraction
Stroke volume / Total volume
- 50-70% - normal ejection fraction
- 40% - 50% - borderline
- < 40 % - systolic heart failure
properties of diastolic heart failure
the heart is not filling enough
- stroke volume is low
- total volume filled up in the ventricles is also low
- therefore ; ejection fraction is normal !
Laplace’s law
- the pressure within the radius of the heart is = tension around the wall of the heart
- increase in preload = increase in radius
- ventricles dilate and remodelled so it stays dilated and easy to dilate further
- same pressure over a greater radius -> increased tension around the wall of the heart ->the more it is stretched -> easier it is to dilate further
How are the stages of heart failure determined?
- New York heart association classification
2. 4 main stages of heart failure
NYHA Class 1
- no limitations of physical activity
- physical activity doesn’t cause ;
- breathlessness
- fatigue
- palpitations