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B - type natriuretic peptide 
 
心室受到 Stretch 時分泌
Volume overload (Ventricular overload)
但老人, DM, Af 都會高
 
生理作用  (跟 ANP 一樣 負責利鈉排水)
 
 - Vasodilatation 降血壓
 - 抑交感 血管擴張 降血壓
 - 促進腎臟 GFR 上升, 排鈉利尿
 - 抑 RAAS
 
Natriuretic peptides produce vasodilation, natriuresis,
decreased levels of endothelin,
and inhibition of the renin-angiotensin-aldosterone system
and the sympathetic nervous systems.

 
 
通常抓 500 為 Cut point 
> 500 算是有意義的高
 
但 BNP 不能用來判定是不是 Acute progression of HF
即使之前 500 現在 1000
也只能說 Poor control 
不能完全代表 Acute heart failure
 
HF 住院, 一開始 BNP 高
治療後症狀改善 若 BNP 也掉下來預後會比較好
若 BNP 依然高, 則預後差
 
 

 
大概很多原因都會高
 
is elevated with any cause of ventricular overload,
including heart failure and strain (both right or left sided), myocardial ischemia,
pulmonary embolism, sepsis, or chronic obstructive pulmonary disease
 
 
Overall, BNP measurement usually is not needed for diagnosis
and adds little impactful prognostic information,
and it is best used when diagnostic uncertainty is present rather than routinely.
 
pro-BNP (<300 picograms/mL) excludes heart failure in low and moderate pretest probability patients
outside of “flash” pulmonary edema setting
 
BNP is recommended when the cause of dyspnea is unclear after standard evaluation;
when the other bedside data make acute heart failure very likely,
these assays add little actionable information
 
limiting usefulness in bedside prognostication in the ED
 

A normal BNP (<100 picograms/mL) or N-terminal pro-BNP (<300 picograms/mL)
excludes heart failure in low and moderate pretest probability
patients outside of “flash” pulmonary edema settings.
 
Conversely, a high level
(BNP >500 picograms/mL or N-terminal pro-BNP > 900 picograms/mL)
is moderately useful for establishing the diagnosis of heart failure.
 
BNP values between 100 - 500 picograms/mL have
no utility in excluding or including heart failure in the dyspneic patient
 
 

NT - pro BNP
 
BNP 的前驅物質
比較穩定, 比較有意義
也能反映出 acute 
 
 
For acute HF :
 
< 50 y/o : 450
50~75 : 900
 > 75 : 1800
 
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    醫學筆記匯整 ED Notes

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