Congestive Heart Failure (CHF)

Order a BNP blood test to measure the levels of a protein called brain natriuretic peptide made by your heart and blood vessels, and levels are higher than normal when you have heart failure. With Ulta Lab Tests, you can order tests directly and learn about your health today!


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Serum alkaline phosphatase levels are of interest in the diagnosis of hepatobiliary disorders and bone disease associated with increased osteoblastic activity. Moderate elevations of alkaline phosphatase may be seen in several conditions that do not involve the liver or bone. Among these are Hodgkin's disease, congestive heart failure, ulcerative colitis, regional enteritis, and intra-abdominal bacterial infections. Elevations are also observed during the third trimester of pregnancy.

When the Total Alkaline Phosphatase activity is increased, the Isoenzymes are useful in determining the source of the increased activity.

BNP is increased in congestive heart failure, left ventricular hypertrophy, acute myocardial infarction, coronary angioplasty, and hypertension. Elevations are also observed in pulmonary hypertension (indicating right ventricular dysfunction), acute lung injury, hypervolemic states, chronic renal failure and cirrhosis. Decreasing levels indicate therapeutic response to anti-hypertensive therapy.

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The BUN/Creatinine ratio is useful in the differential diagnosis of acute or chronic renal disease. Reduced renal perfusion, e.g., congestive heart failure, or recent onset of urinary tract obstruction will result in an increase in BUN/Creatinine ratio. Increased urea formation also results in an increase in the ratio, e.g., gastrointestinal bleeding, trauma, etc. When there is decreased formation of urea as seen in liver disease, there is a decrease in the BUN/Creatinine ratio. In most cases of chronic renal disease the ratio remains relatively normal.

BNP is used to aid in the diagnosis of left ventricular dysfunction in heart failure. In contrast with BNP, a drug to treat left ventricular dysfunction does not interfere with the measurement of N-terminal pro-BNP.

Clinical Significance

Urine chloride excretion approximates the dietary intake. The chloride content of most foods parallel that of sodium. An increase in urine chloride may result from water deficient dehydration, diabetic acidosis, Addison's disease, and salt-losing renal disease. Decreased urine levels are seen in congestive heart failure, severe diaphoresis and in hypochloremic metabolic alkalosis due to prolonged vomiting.


A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)


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Digoxin is a cardiac glycoside derived from the digitalis plant. It is used to treat congestive heart failure and atrial dysrhythmias. Digoxin levels are monitored to assure adequate therapeutic levels are achieved and to avoid toxicity.

Galectin-3

Clinical Significance

A galectin-3 test may be ordered for the identification of individuals with chronic heart failure at elevated risk of disease progression.

Performing Laboratory 

Cleveland HeartLab, Inc 
6701 Carnegie Avenue, Suite 500
Cleveland, OH 44103-4623

Metanephrines, Fractionated, Free, LC/MS/MS, Plasma

Patient Preparation: Patient should avoid alcohol, coffee, tea, tobacco and strenuous exercise prior to collection. Overnight fasting is preferred. Patients should be relaxed in either a supine or upright position before blood is drawn.

Limitations: False-positive results have been observed in patients with either chronic kidney disease or hypertension.

Clinical Significance: Normetanephrine (NM) and metanephrine (MN) are the extra-neuronal catechol-o-methyl transferase (COMT) metabolites of the catecholamines norepinephrine and epinephrine, respectively. Measurement of plasma metanephrines is more sensitive (but may be less specific) than measurement of catecholamines for the detection of pheochromocytoma. Proper interpretation of results requires awareness of recent medication/drug history (e.g., antyhypertensive agents, alcohol, cocaine) and other pre-analytical factors (e.g., stress, severe congestive heart failure, myocardial infarction) that influence release of catecholamines and metanephrines.


Metanephrines, Fractionated, LC/MS/MS, 24-Hour Urine

Includes: Metanephrine, Normetanephrine, Total Metanephrines

Patient Preparation : It is preferable for the patient to be off medications for three days prior to collection. Patient should avoid tobacco, tea, coffee, for three days prior to specimen collection. Common antihypertensives (diuretics, ACE inhibitors, calcium channel blockers, alpha and beta blockers) cause minimal or no interference. Medications which are alpha agonists (Aldomet), alpha blockers (Dibenzyline) should be avoided 18-24 hours prior to specimen collection.

Preferred Specimen(s) : 5 mL 24-hour urine with 25 mL 6N HCl collected in a 24-hour urine container 

Clinical Significance: Test is useful in the evaluation of pheochromocytoma.


Metanephrines, Fractionated, LC/MS/MS, Random Urine 

Includes: Metanephrines, Normetanephrines, Total Metanephrines, Creatinine

Patient Preparation: It is preferable for the patient to be off medications for three days prior to collection. Patient should avoid tobacco, tea, coffee, for three days prior to specimen collection. Common antihypertensives (diuretics, ACE inhibitors, calcium channel blockers, alpha and beta blockers) cause minimal or no interference. Medications which are alpha agonists (Aldomet), alpha blockers (Dibenzyline) should be avoided 18-24 hours prior to specimen collection.

 


Plasma norepinephrine is an independent risk factor in patients with chronic congestive heart failure that relates to subsequent mortality. Norepinephrine is useful in evaluating patients with hypertension


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BNP is used to aid in the diagnosis of left ventricular dysfunction in heart failure. In contrast with BNP, a drug to treat left ventricular dysfunction does not interfere with the measurement of N-terminal pro-BNP.

Dietary supplements containing biotin may interfere in assays and may skew results to be either falsely high or falsely low. For patients receiving the recommended daily doses of biotin, draw samples at least 8 hours following the last biotin supplementation. For patients on mega-doses of biotin supplements, draw samples at least 72 hours following the last biotin supplementation.


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Urea is the principle waste product of protein catabolism. BUN is most commonly measured in the diagnosis and treatment of certain renal and metabolic diseases. Increased BUN concentration may result from increased production of urea due to (1) diet or excessive destruction of cellular proteins as occurs in massive infection and fevers, (2) reduced renal perfusion resulting from dehydration or heart failure, (3) nearly all types of kidney disease, and (4) mechanical obstruction to urine excretion such as is caused by stones, tumors, infection, or stricture. Decreased urea levels are less frequent and occur primarily in advanced liver disease and in overhydration


Congestive Heart Failure is also known as CHF or heart failure. Whatever you call it, this condition is one where the human heart is unable to pump blood with the efficiency that it once did. This means that blood, as well as other various fluids, start backing up inside the body. The effect is particularly pronounced in the feet, hands, lungs, and liver. 

The human heart has two different sides to it, as well as four different chambers. The right side is what takes in blood depleted of oxygen from throughout the body, sending it into the lungs. Once the lungs replenish the oxygen in the blood, it’s the left side that pumps this fresh blood back out into the overall body. 

Congestive Heart Failure is a very serious condition, one that is progressive. It’s often chronic, and it can threaten your life. It might impact the left side of the heart, the right side, or even both sides. Those with CHF have lowered amounts of nutrients and oxygen delivered to their organs, resulting in lost functions and damage. 

CHF can happen for several different reasons. Most frequently, the heart undergoes damage, which might be hypertension/high blood pressure, prior heart attacks, or even cardiomyopathy, which is direct damage right to the actual heart muscle. Congestive Heart Failure can also happen if there is any damage to the heart valves or pericardium scarring to the membrane that physically surrounds the human heart. On rare occasions, CHF happens if the heart must start beating with more force than is typical, as which can happen with hyperthyroidism, where it simply can’t keep up with the current demand. Congestive Heart Failure risks are elevated among those with diabetes, the overweight and obese, smokers, and anyone who abuses cocaine and/or alcohol. 

CHF is very common in elderly individuals since the human heart tends to lose efficiency with age. The National Heart, Lung and Blood Institute has estimates showing that between 5.5 and 6 million Americans have heart failure at any given time. For those older than 65, it’s among the most frequent reasons for hospitalization. 

Symptoms/Signs 

When blood backs up starting from the heart’s right side, then Congestive Heart Failure symptoms typically start with ankles and legs swelling in ways that get worse if a person stands up but gets better if they lie down. If blood starts backing up from the heart’s left side, then it moves into the lungs, resulting in coughing or breathing, particularly during periods of lying down flat or exercise, even if it’s just walking up a set of stairs. Many individuals that suffer heart failure have demonstrated symptoms of blood that’s backing up simultaneously on both sides of the heart. 

On top of shortness of breath and edema/swelling, other symptoms can include the following: 

  • Rapid pulse, heart palpitations 
  • Fatigue, weakness 
  • Less stamina, lower ability to do physical exercise 
  • Wheezing, coughing 
  • Sudden gains of weight 
  • Lost appetite 
  • Nausea 

Laboratory testing can include the following: 

BNP or N-terminal pro-BNP: BNP stands for B-type natriuretic peptide, which is a measurement of concentrations of a specific hormone the left ventricle produces. Given its role as the heart’s primary pumping chamber, the left ventricle’s production of BNP helps doctors both diagnose and grade how serious heart failure is. 

Metabolic Panel: This looks for things like liver disease, electrolyte imbalances, and kidney failure, given how many kidney disease symptoms are very similar to the ones of Congestive Heart Failure. 

CBC: A complete blood count looks for anemia, which not only has symptoms like CHF but can also contribute to CHF. 

Thyroid Testing: Such tests check the thyroid hormone levels in the blood. Heart failure can result from both hyperthyroidism and hypothyroidism, which are respectively too much or too little thyroid hormone. 

Two relatively new tests are now available for those already diagnosed with CHF to predict their prognosis. ST2 and Galectin-3 tests both measure protein levels in the blood. If these biomarkers are elevated, they might indicate someone who has heart failure is at a higher risk of complications and requires more assertive levels of treatment.