Skip to Main Content

Chapter 2. Acute Decompensated Heart Failure

RF is a 62-year-old man with nonischemic cardiomyopathy (LVEF 30%-35%) presenting to the emergency department (ED) with an acute HF exacerbation. His vital signs include BP 155/90 mm Hg, heart rate (HR) 85 beats/min, RR 20, and O2 sat 94% on 4 L/min of oxygen by nasal cannula (NC). Physical examination reveals jugular venous distension (JVD), regular rate and rhythm (RRR), crackles bilaterally at bases, and 2+ bilateral lower extremity edema. He admits to a 12-lb weight gain in the past 2 weeks since his carvedilol dose was increased and reports strict adherence to both dietary restrictions and medications. In the ED, he has already received furosemide 80 mg IV ×1 dose with minimal response in urine output. Pertinent laboratory results include potassium 3.9 mmol/L, BNP 1550 pg/mL, BUN 37 mg/dL, and SCr 1.3 mg/dL (baseline). RF’s home medications include lisinopril 10 mg daily, carvedilol 25 mg twice daily, digoxin 0.125 mg/d, and furosemide 80 mg orally twice daily.

Based on the BNP value, RF is experiencing which one of the following?

a. Active myocardial ischemia

b. Shortness of breath due to a noncardiac etiology

c. Significant volume overload and ventricular wall stretch

d. Renal insufficiency

Answer c is correct. Brain natriuretic peptide (BNP) is released and elevated in the setting of significant volume overload causing stretch of the ventricular wall.

Answer a is incorrect. Common laboratory tests for assessing active myocardial ischemia include creatinine kinase, creatinine kinase-myocardial fraction, and troponin.

Answer b is incorrect. BNP may be used to rule out other etiologies of shortness of breath due to a noncardiac etiology, in which cases the BNP level will be normal. RF’s shortness of breath (SOB) is due to a heart failure exacerbation with pulmonary edema from cardiac failure, which would be a cardiac etiology.

Answer d is incorrect. While BNP may be altered in the setting of renal insufficiency, it is not to the same degree as the level of elevations which occurs in the setting of fluid overload.

RF is a 62-year-old man with nonischemic cardiomyopathy (LVEF 30%-35%) presenting to the emergency department (ED) with an acute HF exacerbation. His vital signs include BP 155/90 mm Hg, heart rate (HR) 85 beats/min, RR 20, and O2 sat 94% on 4 L/min of oxygen by nasal cannula (NC). Physical examination reveals jugular venous distension (JVD), regular rate and rhythm (RRR), crackles bilaterally at bases, and 2+ bilateral lower extremity edema. He admits to a 12-lb weight gain in the past 2 weeks since his carvedilol dose was increased and reports strict adherence to both ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.