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Revision as of 15:20, 18 March 2013

Right heart failure Microchapters

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Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Right heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

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Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jad Z Al Danaf; Rim Halaby

Overview

Laboratory tests are useless in the diagnosis of heart failure, however they are essential in identifying possible precipitating factors of decompensation, assessing severity of the heart failure, monitoring the side effects of medical treatment and some serve as prognostic markers.[1] In addition, in patients with right heart failure, an arterial blood gas can be useful in assessing the degree of hypoxemia. This can in turn be used to guide therapy with oxygen.

Laboratory Findings

Complete Blood Count (CBC)[2]

  • Anemia might trigger decompensation of heart failure.
  • Low lymphocyte >7000/µL basal white blood cell count and ESR >15mm in first hour might indicate worse prognosis
  • CBC is to be repeated every 6 months unless needed to be repeated more frequently.

Serum Electrolytes and Creatinine[2]

Serum Uric Acid

Liver Function Tests

Coagulation Tests

  • INR especially during anticoagulant therapy or in setting of hepatic dysfunction-nutmeg liver must be measured.

Cardiac Troponins

  • Highly sensitive troponin I (hs-cTnI) serves as outcome predictors with more sensitivity then cardiac troponin T (cTnT).

Thyroid Hormones

Neurohormonal Prognostic Markers

Shown below is a table summarizing the interpretation of the levels of BNP and NT-proBNP levels.

BNP NT-proBNP Comment
<100 pg/mL <300 pg/mL Unlikely decompensated heart failure
>500 pg/mL >900 pg/mL (50-75 years old) Likely decompensated heart failure
>1,800 pg/mL (>75 years old) Likely decompensated heart failure

References

  1. Tago WH, Francis GS, Morrow DA, et al. National Academy of Clinical Biochemistry Laboratory Medicine. National Academy of Clinical Biochemistry Laboratory Medicine practice guidelines: Clinical utilization of cardiac biomarker testing in heart failure. Circulation. 2007; 116:e90-e109.
  2. 2.0 2.1 Van der Meer P. and Van Veldhuisen DJ. Anaemia and renal dysfunction in chronic heart failure. Heart. 2009; 95: 1808-1812.
  3. Haddad F. et al. Right Ventricular function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Importance and Management of Right Ventricular failure. Circulation. 2008;117:1717-1731
  4. Maeder M, Fehr T, Rickli H, Ammann P. Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides. Chest. 2006;129:1349 –1366.
  5. Pousset F, Isnard R, Lecnat R et al. Prognostic value of plasma endothelin-1 in patients with chroninc heart failure. Eur Heart J. 1997; 18:254-258.
  6. Hobbs RE. Using BNP to diagnose, manage, and treat heart failure. Cleve Clin J Med 2003;70:333–6.

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