Heart Failure: DIAGNOSTIC TESTS

Assessment & Diagnostic Findings

HF may go undetected until the patient presents with *signs and symptoms of pulmonary and peripheral edema*. Some of the physical signs that suggest HF may also occur with other diseases, such as *kidney injury and COPD*; therefore, diagnostic testing is essential to confirm a diagnosis of HF. *Assessment of ventricular function* is an essential part of the initial diagnostic workup. An *echocardiogram* is usually performed to determine the EF, identify anatomic features such as structural abnormalities and valve malfunction, and confirm the diagnosis of HF. This information may also be obtained noninvasively by radionuclide ventriculography or invasively by ventriculography as part of a cardiac catheterization procedure. Differential identification of systolic and diastolic HF is important, as treatment differs A *chest x-ray* and a *12-lead electrocardiogram (ECG)* are obtained to assist in the diagnosis. Laboratory studies usually performed during the initial workup include serum *electrolytes,* * blood urea nitrogen (BUN), creatinine,* *LFT*, *thyroid-stimulating hormone,* *complete blood count (CBC), BNP,* and routine *UA-urinalysis.* The *BNP* level is a *KEY DIAGNOSTIC* indicator of HF; high levels are a sign of *high cardiac filling* *pressure* and can *aid in both the diagnosis* and *management of HF* The results of these laboratory studies assist in determining the underlying cause and can also be used to establish a baseline to assess effects of treatment. *Cardiac stress testing or cardiac catheterization* may be performed to determine whether CAD and cardiac ischemia are causing the HF.

Atrial natriuretic peptide *(ANP)* Brain natriuretic peptide *(BNP)*

Hormones released by heart muscle and increased in heart failure

As severity of left ventricular failure increases_______________________

*BNP levels increase* Also *elevated in women and individuals > 60 yrs* old

*decreasing BNP levels at 2-hour intervals*

*Response to TX measured by *

Heart Failure: DIAGNOSTIC TESTS

- S&Sx of pulmonary and peripheral edema* - HF may go undetected until the patient presents with them -*Assessment of ventricular function* - an essential part of the initial diagnostic workup -*LAB STUDIES*: hormones released by heart muscle and increased in heart failure *Atrial* natriuretic peptide *(ANP)* *Brain* natriuretic peptide *(BNP)* As *severity of left ventricular failure increases*, BNP levels increase Also *elevated in women and individuals > 60 years old* E-lytes UA, BUN & Creatinine Liver Function tests-LFT Thyroid function test Arterial Blood Gas-ABG - *Chest X-ray, ECG, ECHO & Doppler flow studies* - *Cardiac stress testing or cardiac catheterization*: performed to determine whether CAD and cardiac ischemia are causing the HF.

Diagnostic of CHF

Brain Natriuretic Peptide (BNP)=___________ < 80 pglml = negative 100-200 = Class I Heart Failure 200-300 pglml = Class II Heart Failure 300-400 pglml = Class III Heart Failure > 400 pglml = Class IV Heart Failure

*BNP*

is a key diagnostic indicator of HF; -high levels are a sign of *high cardiac filling* *pressure* and can *aid in both the diagnosis* and *management of HF*