Dr. Isaac Gana
Cardiology
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Patient's Query
Hello doctor,
I will try to be brief. I am a 49 year old female who has been pacemaker dependent for several years. Due to cardiomyopathy EF of 30 %, BNP of 186, and a cardiac event resulting in high troponin. I eventually was switched to a biventricular pacemaker or defibrillator. I had an echo last week (three months post implant) and was happy to hear that my EF is now 50 %. However, I continue to get edema and dyspnea all the time, and my BNP is now up to 490 pg/mL. Can you help me understand what this means?
Hello,
Welcome to icliniq.com.
I understand your concern. Although your ejection fraction is now 50%, your BNP (brain natriuretic peptide) value is high which is the reason you are experiencing edema and dyspnea. Increased BNP causes a fluid and pressure increase in your heart, which in turn manifests as edema and dyspnea. It simply means you are still having a heart failure. It is very good that your pacemaker was switched to a biventricular one. In my practice, we use beta blockers and ACE (angiotensin-converting enzyme) inhibitors in combination more aggressively in similar situations. I sincerely do wish you a quick recovery. Best regards.
Patient's Query
Hello doctor,
Thank you so much for answering my question. What is the general prognosis for a heart failure with a high BNP, despite aggressive medication therapy?
Hello,
Welcome back to icliniq.com.
This will depend on different factors like if you have arrhythmias, the response to current treatment, etc. Normally the higher the BNP, the higher the chance of sudden cardiac death but, a bi-ventricular pacemaker helps reduce that chance. So, the prognosis can be determined only by a combination of various factors. Best regards.
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Cardiology
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