Neurohormonal regulation and the overlapping pathology between heart failure and acute coronary syndromes.
An understanding of the dynamic relationship between the coronary artery and left ventricular (LV) function is important in diagnosing and treating acute coronary disease. Measurement of B-type natriuretic peptide (BNP) provides rapid and accurate identification of patients with impaired LV function, which has proven valuable in differentiating between congestive heart failure (CHF) and symptoms attributable to pulmonary etiologies. Coronary artery and ventricular pathophysiology both are characterized by injury, functional aberrations, and subsequent remodeling. Ischemia occurs in both and accounts for virtually all significant adverse outcomes. The difference in BNP elevations seen in acute ischemia compared with those observed in chronic CHF is striking: Although even small BNP elevations in acute coronary syndromes have powerful prognostic value, it is not likely that they can be effectively used as a diagnostic marker for ischemia.
Jesse
Robert L
RL
Virginia Commonwealth University Health System, Veterans Health Administration, Richmond, Virginia, USA.
D000208:Acute Disease; D003327:Coronary Disease / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood; D018377:Neurotransmitter Agents / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology; D013577:Syndrome; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
D018377:Neurotransmitter Agents; D020097:Natriuretic Peptide, Brain