Body fluids and electrolytes
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
Two cardiac hormones, ANP and BNP, also provide short-term assistance to maintain balance. ANP is stored in the cardiomyocytes in the right atrium and is released when atrial ‘stretch’ is sensed. It opposes the effect of the renin–angiotensin–aldosterone system, causing vasodilation, increasing glomerular filtration and decreasing antidiuretic hormone (ADH) release from the pituitary gland. BNP, or brain-type or B-type natriuretic peptide, is secreted by the cardiac ventricles of the heart in response to ‘stretch’. Its actions are similar to ANP but with a longer half-life. BNP is an indicator of heart failure because its concentration is raised in the serum of patients who have enlarged hearts (see ‘Heart failure’ in Chapter 6).
Practice Paper 2: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Brain-type natriuretic peptide (BNP) is a serum marker for impaired left ventricular function that is rarely raised in individuals with normal cardiac function. It is secreted from the ventricles in response to pressure overload, and acts to reduce systemic vascular resistance and cardiac preload while promoting natriuresis (the excretion of large amounts of sodium in the urine). BNP should be used alongside ECG, chest X-ray, thyroid function tests and baseline biochemistry and haematology results to identify patients who require further imaging and assessment. Patients with a normal ECG and negative BNP are unlikely to have heart failure. In addition to its diagnostic role, BNP may have a prognostic value, as higher serum levels are associated with more severe disease. Transthoracic Doppler echocardiogram (TTE) is also useful in the initial assessment of cardiac failure to visualize the heart valves, blood flow and endocardium. Natriuresis, from Latin natrium = sodium + Greek ourein = to urinate.
Erythropoietin, Atrial Natriuretic Peptide and Sex Hormones
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal in Principles of Physiology for the Anaesthetist, 2020
Brain natriuretic peptide (BNP) is a 32-amino-acid peptide that is structurally similar to ANP and shares the same guanylate cyclase receptors on the endothelial cells. BNP was first isolated in porcine brain but has subsequently been found in cardiac tissue. BNP is secreted predominantly from the ventricular muscle cells in response to ventricular dilation, although smaller amounts may be released from atrial cells. The physiological actions of BNP are similar to those of ANP, resulting in enhanced diuresis and natriuresis, vasodilatation and a reduction in aldosterone.
Usefulness of Serial Brain Natriuretic Peptide Measurements for Managing Aortic Valve Stenosis in Pregnancy
Published in Baylor University Medical Center Proceedings, 2009
Sneha Patel, Paul A. Grayburn, Shyla T. High, Jon Rosnes, James W. Choi
Among developed countries, valvular aortic stenosis (AS) in pregnant women is primarily due to a congenitally bicuspid aortic valve, which occurs in ~1% of the general adult population. Most asymptomatic patients and those with mild to moderate AS can be managed conservatively to full-term pregnancy. However, those with more severe AS with symptoms require more aggressive treatment. The medical management of severe symptomatic AS is not ideal; hence, these women are typically treated with percutaneous balloon valvuloplasty or surgical aortic valve replacement. However, both interventions are associated with inherent risks. In addition, symptoms such as dyspnea and decreased exercise tolerance are commonly exhibited in normal pregnant women, making it difficult to distinguish symptoms associated with normal pregnancy from those caused by AS. We report the first case of congenitally bicuspid severe AS in pregnancy that was successfully managed medically to full term by following consecutive brain natriuretic peptide levels.
Association of serum N-terminal pro-brain natriuretic peptide levels with the severity of preeclampsia
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2016
Murat Bakacak, Salih Serin, Onder Ercan, Bülent Köstü, Zeyneb Bakacak, Hakan Kiran
Objective: To investigate whether serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels could be used as a marker to determine the severity of preeclampsia. Methods: This prospective cohort study included pregnant women with preeclampsia and severe preeclampsia and normotensive pregnant controls admitted between January 2013 and July 2014. Preeclampsia was graded according to the recently revised criteria of the American College of Obstetricians and Gynecologists (ACOG). Serum NT-proBNP levels were compared among the groups. Results: Of the 49 women with preeclampsia, 25 had severe preeclampsia. The controls were 27 normotensive pregnant women admitted during the same period. Serum NT-proBNP levels were significantly higher in the preeclampsia groups than in the control group (p
The prognostic value of copeptin in patients with acute chest pain
Published in Expert Review of Cardiovascular Therapy, 2014
Nicholas A Marston, Alan S Maisel
The prognostic value of copeptin in acute chest pain is an area of rapid growth and research interest. Copeptin has already established a role in early diagnosis and rule out of acute myocardial infarction, but as its use increases much of the attention has been directed at the prognostic value of copeptin. This article reviews the growing body of evidence supporting the use of copeptin to further risk-stratify chest pain patients. The studies included address a variety of populations ranging from all patients presenting with chest pain to those who are at high risk, diagnosed with acute coronary syndrome or found to have left ventricular dysfunction. Many of the studies compare and combine the prognostic value of copeptin with other prognostic markers such as troponin, brain natriuretic peptide and Global Registry of Acute Coronary Events scores. Caveats of copeptin are also discussed such as gender differences, cutoff points and the importance of timing in the copeptin assay.
Related Knowledge Centers
- Diuresis
- Electrolyte Balance
- Peptide
- Renin
- Vasodilation
- Amino Acids
- Natriuretic Peptides