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Deciphering BNP
By Kim McCarron, RN, CRNP, MS
Clinical Associate Professor • Towson University • Towson, Md.
Benjamin Labovitz
Senior Nursing Student • Towson University • Towson, Md.
Mary Hartley, 82, comes to your ED with BNP is present in minute quantities in a
BNP is a noticeable fatigue and breathlessness. She healthy person, but levels rise significantly
protein first has 3+ pretibial edema and an oxygen satu- in response to cardiac chamber stretch.
discovered ration value of 86% on room air. Her initial When the ventricles become distended due
in the brains brain natriuretic peptide (BNP) level, which to volume overload, BNP production is
is drawn within 30 minutes of admission, is stimulated. Type A receptors, present in
3,266 pg/mL. Eighteen hours later after large blood vessels and kidney and adrenal
of pigs.
furosemide, a beta-blocker, and an an- tissue, respond to rising levels of BNP and
giotensin-converting enzyme (ACE) in- through assorted mechanisms work to pro-
hibitor are prescribed and oxygen is ad- mote homeostasis. It’s important to note
ministered, her BNP level continues to that age and gender are influencing factors.
rise at 3,405 pg/mL. One day later, BNP levels increase in both genders as a
with continued therapy, her BNP level person ages, and women secrete higher
drops to 2,462 pg/mL and 2 days later, plasma levels of BNP. BNP levels are lower
it has dropped to 1,050 pg/mL and her in obese individuals and among patients
symptoms have markedly improved. who are prescribed diuretics, ACE inhib-
Mrs. Hartley’s heart failure is classi- itors, digoxin, or vasodilators.
fied as New York Heart Association
(NYHA) Class IV and biventricu- Determining heart failure
lar pacing is prescribed to assist Current heart failure practice guidelines
her failing myocardial pump. support drawing BNP levels for patients
If you practice in an ED or car- who arrive at the urgent care setting and
diac area, many of your patients for whom the clinical diagnosis of heart
will have BNP values drawn. I’ll failure is uncertain. Heart failure patients
help you understand what this diagnostic typically present with fatigue, dyspnea, de-
test reveals about your patient’s condition. creased oxygen saturation, and weight
gain as fluid is retained in body tissues.
Nature’s diuretic This constellation of symptoms may indi-
In practical terms, natriuresis is the elimi- cate left ventricular systolic or diastolic
nation of sodium and water from the re- dysfunction or right ventricular pressure
nal tubules, and for this reason BNP can overload states such as pulmonary em-
be considered nature’s diuretic. Natriure- bolism, cor pulmonale, or primary pul-
sis also causes arteriolar and venous va- monary hypertension. Also, conditions that
sodilation, with the effect of lowering BP. cause extracellular fluid volume expansion,
BNP reduces output from the sympathetic such as renal failure and liver cirrhosis,
nervous system and the renin-angioten- will result in elevated levels of natriuretic
sion-aldosterone system, moderating heart hormones.
rate and cardiac afterload. It has a bonus In addition to differentiating heart failure
effect of endothelial protection and in- from other disorders, BNP assessment is
hibits ventricular remodeling, lessening used as a prognostic marker in cardiac
the harmful structural changes that result patients. After a patient is diagnosed with
in hypertrophy of cardiac muscle. heart failure, it’s staged functionally accord-
BNP (pg/mL)
BNP is detectable from 5 to 5,000 pg/mL. If
the patient’s serum level is less than 100
pg/mL, conditions other than heart failure
are explored as the cause of dyspnea. A value
500
the third heart sound (S3), and assessing for Fischbach F. A Manual of Laboratory and Diagnostic Tests.
7th ed. Philadelphia, PA: Lippincott Williams & Wilkins;
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encing symptoms of heart failure. In addi- cardiac rehabilitation and brain natriuretic peptide. Nurse
Pract. 2004; 29(3):36-39.
tion, the echocardiogram is regarded as the
Kinkade E, Frazier SK. BNP assays: predicting the future
gold standard for assessment of heart failure. of CHF patients. Nurse Pract. 2006;31(13):36-41.
Echocardiography has a greater sensitivity Sikaris K. BNP—considering a heartfelt message. Heart
and specificity than BNP measurement and Lung Circ. 2004;13(suppl 3):S31-S37.