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What Does This Pro BNP Levels Indicate?
Question: Doc.This is reg my mom aged 94 now.She had a major heart attack during 2009 and it was resolved with dissolving clot by medicine s and after that regular follow up with cardio till few years back.Now the present issue is given below.
1) we took an Echo and Chest X ray in the year 2019...it's almost 18 month now.Both report s attached.These were reviewed with Cardio who said it is as per age condition..and not a case of heart failure.
2) Now last couple of months the symptoms are heart rate goes up to 90 to 95 after any food intake and at rest around 80..BP varies too.On consulting with GP she has increased the Metoprolol XL 50 to thrice a day..along with Telma 20 .she is also taking regularly Dilnip 5 mg twice a day also since last 6 months inplace of Amlosafe 5 mg since Amlosafe was causing pedal oedema.Gp also advised to take Dytor 2.5 mg per day considering patient condition only whenever there is pedal oedema
3).Issue is inspite of above dosages..her heart rate touches 95 after even a small cup of solid food..She gets in to discomfort etc and it takes 1 hour to come to normal ..
4)she is fine only when her rate is around 70 which happens only after good night sleep.
GP was suspecting some level of heart failure ....and says only echo will tell..WHAT I HAVE ENCLOSED IS TAKEN 18 MONTHS BACK....
5) last week we took a Blood test and NT -pro-BNP level was found to be 2864 pg/ml.Sodium 135.. Potassium 4.7.Serum creatinine and BUN normal levels.Albumin at 3 .3...HB at 11.9 .C RP as per dat lab is 4.7 For that lab them CR p till 5 is normal.
test also done for hyper thyroidism and all thryroid parameters are normal .
Now I have the following queries.
1) what does this Pro BNP levels indicate?
2 )Do the above medicine s are correct or any more dosage needed or reduced?
3 ) what is the safe dosage of Metoprolol in a day?? Can Metoprolol XL 50 can be safely given 4 times in a day??to control Heart rate around 70?
Or Can Dilnip dosage be increased to 10 mg twice a day??Do calcium channel blockers advised in this condition as it causes oedema in ankles...Any other alternative or continue Dilnip at 5 mg twice a day??
Do Temisartan not advised when potassium touches 5 mmo/L??she few months back touched potassium at 5 level s and then only Dilnip was given in place of TelmaH 40 once a day.
CAN TELMA BE SAFELY given even when Potassium touches 5???
How to reduce pedal oedema??
She gets into Breathless XXXXXXX too at times....
Another important medicine she is taking till today is NICORANDIL 5 mg twice a day and also Clopilet 75 mg once a day.IS NICORANDIL advised in this condition of heart failure?? Does it offer any help??
KINDLY GO THRO THE ABOVE PATIENTLY AND ADVISE AND CLEAR DOUBTS RAISED
Patient is now 94 and confined to bed mostly.Get up only for food and toilet.
Most noticeable clinical symptoms which is causing discomfort is Increased heart rate to 95 level which gives so much of discomfort like coarseness in voice..breathless XXXXXXX .She feels better to sit than sleep whenever rate shoots up ..
we always see Oxygen saturation levels at home with pulse oximeter and get reading above 95% to touching 98 or 99% also.
KLY ADVISE .
HOW to bring beats to around 60 to 70 levels?which I feel she will be fine?
Is this what level of heart failure ? How is prognosis??
Shd we increase DYTOR DOSAGE
TO DAILY ? OR TRY DYTOR PLUS??
Any other specific medicine to be given considering her above condition?
1) we took an Echo and Chest X ray in the year 2019...it's almost 18 month now.Both report s attached.These were reviewed with Cardio who said it is as per age condition..and not a case of heart failure.
2) Now last couple of months the symptoms are heart rate goes up to 90 to 95 after any food intake and at rest around 80..BP varies too.On consulting with GP she has increased the Metoprolol XL 50 to thrice a day..along with Telma 20 .she is also taking regularly Dilnip 5 mg twice a day also since last 6 months inplace of Amlosafe 5 mg since Amlosafe was causing pedal oedema.Gp also advised to take Dytor 2.5 mg per day considering patient condition only whenever there is pedal oedema
3).Issue is inspite of above dosages..her heart rate touches 95 after even a small cup of solid food..She gets in to discomfort etc and it takes 1 hour to come to normal ..
4)she is fine only when her rate is around 70 which happens only after good night sleep.
GP was suspecting some level of heart failure ....and says only echo will tell..WHAT I HAVE ENCLOSED IS TAKEN 18 MONTHS BACK....
5) last week we took a Blood test and NT -pro-BNP level was found to be 2864 pg/ml.Sodium 135.. Potassium 4.7.Serum creatinine and BUN normal levels.Albumin at 3 .3...HB at 11.9 .C RP as per dat lab is 4.7 For that lab them CR p till 5 is normal.
test also done for hyper thyroidism and all thryroid parameters are normal .
Now I have the following queries.
1) what does this Pro BNP levels indicate?
2 )Do the above medicine s are correct or any more dosage needed or reduced?
3 ) what is the safe dosage of Metoprolol in a day?? Can Metoprolol XL 50 can be safely given 4 times in a day??to control Heart rate around 70?
Or Can Dilnip dosage be increased to 10 mg twice a day??Do calcium channel blockers advised in this condition as it causes oedema in ankles...Any other alternative or continue Dilnip at 5 mg twice a day??
Do Temisartan not advised when potassium touches 5 mmo/L??she few months back touched potassium at 5 level s and then only Dilnip was given in place of TelmaH 40 once a day.
CAN TELMA BE SAFELY given even when Potassium touches 5???
How to reduce pedal oedema??
She gets into Breathless XXXXXXX too at times....
Another important medicine she is taking till today is NICORANDIL 5 mg twice a day and also Clopilet 75 mg once a day.IS NICORANDIL advised in this condition of heart failure?? Does it offer any help??
KINDLY GO THRO THE ABOVE PATIENTLY AND ADVISE AND CLEAR DOUBTS RAISED
Patient is now 94 and confined to bed mostly.Get up only for food and toilet.
Most noticeable clinical symptoms which is causing discomfort is Increased heart rate to 95 level which gives so much of discomfort like coarseness in voice..breathless XXXXXXX .She feels better to sit than sleep whenever rate shoots up ..
we always see Oxygen saturation levels at home with pulse oximeter and get reading above 95% to touching 98 or 99% also.
KLY ADVISE .
HOW to bring beats to around 60 to 70 levels?which I feel she will be fine?
Is this what level of heart failure ? How is prognosis??
Shd we increase DYTOR DOSAGE
TO DAILY ? OR TRY DYTOR PLUS??
Any other specific medicine to be given considering her above condition?
Brief Answer:
Kindly refer to the detailed answer below
Detailed Answer:
Hello
After carefully going through your medical query and issues raised by you I would like to tell you that all her symptoms can be due to heart failure as raised BNP, pedal oedema and breathlessness.
Electrolyte imbalance can be associated commonly and usually managed with medication modifications.
Considering her age and symptoms I would like to advise you to get a fresh echocardiography done so that heart failure can be diagnosed. Also get an ECG done to check if heart is working in a rhythm ( fluctuation in heart rate or palpitations can be indicating towards cardiac arrhythmias)
Hypertension medications can be given in higher dose to get a good control on blood pressure.
Kindly get a fresh ECG and a echocardiography done and get back to me with reports for further opinion.
Kind Regards
Dr Bhanu Partap
Kindly refer to the detailed answer below
Detailed Answer:
Hello
After carefully going through your medical query and issues raised by you I would like to tell you that all her symptoms can be due to heart failure as raised BNP, pedal oedema and breathlessness.
Electrolyte imbalance can be associated commonly and usually managed with medication modifications.
Considering her age and symptoms I would like to advise you to get a fresh echocardiography done so that heart failure can be diagnosed. Also get an ECG done to check if heart is working in a rhythm ( fluctuation in heart rate or palpitations can be indicating towards cardiac arrhythmias)
Hypertension medications can be given in higher dose to get a good control on blood pressure.
Kindly get a fresh ECG and a echocardiography done and get back to me with reports for further opinion.
Kind Regards
Dr Bhanu Partap
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Doc.Thanx for the reply.I would try to take ECHO & ECG n get back to you.Meanwhile pl clarify the following.
1) Did u see the previous EChO report?? Since I have doubt whether I attached the same properly or not?Last echo report LVEF was 43%.Can that detiorate at a faster rate in 18 months??
2) Can Prolomet XL 50 be given four times in a day as advised by GP?? What is the maximum permissible dosage in a day?
3)Can Dilnip dosage be continued at 5 mg twice a day???or when need based be increased?
4)Is NICORANDIL 5 mgTwice a day is useful ???
5)Telma 40 mg once can be given or Telma H?? Our GP once stopped it after seeing Pottasium touching 5 levels and switched to Amlosafe...
6) Is it advisable to give daily AB phyliine SR tablet 200 mg daily?? Our GP is saying it can be given on need based ...Daily she used to take before bed AB phyliine syrup one spoon earlier.kly advise on this.
I will get back to you after getting ECG n echo at the earliest.Meanwhile pl clarify my point wise querries as as asked above.
Thanking you.
1) Did u see the previous EChO report?? Since I have doubt whether I attached the same properly or not?Last echo report LVEF was 43%.Can that detiorate at a faster rate in 18 months??
2) Can Prolomet XL 50 be given four times in a day as advised by GP?? What is the maximum permissible dosage in a day?
3)Can Dilnip dosage be continued at 5 mg twice a day???or when need based be increased?
4)Is NICORANDIL 5 mgTwice a day is useful ???
5)Telma 40 mg once can be given or Telma H?? Our GP once stopped it after seeing Pottasium touching 5 levels and switched to Amlosafe...
6) Is it advisable to give daily AB phyliine SR tablet 200 mg daily?? Our GP is saying it can be given on need based ...Daily she used to take before bed AB phyliine syrup one spoon earlier.kly advise on this.
I will get back to you after getting ECG n echo at the earliest.Meanwhile pl clarify my point wise querries as as asked above.
Thanking you.
Brief Answer:
Please refer to the detailed answer below
Detailed Answer:
1. I am sorry but I am not able to see any reports attached with your query. Please try to upload them again. Yes, heart function can deteriorate in this much time, so a review echo is advisable every year.
2. Yes, metoprolol can given upto 200mg a day depending upon patients blood pressure response.
3. 10 mg a day can be given safely, again patient bp response must be monitored.
4. Yes telma can be used. With Telma H potassium should be monitored.
5. AB Phylline must be taken as per your doctors advice.
Kind Regards
Please refer to the detailed answer below
Detailed Answer:
1. I am sorry but I am not able to see any reports attached with your query. Please try to upload them again. Yes, heart function can deteriorate in this much time, so a review echo is advisable every year.
2. Yes, metoprolol can given upto 200mg a day depending upon patients blood pressure response.
3. 10 mg a day can be given safely, again patient bp response must be monitored.
4. Yes telma can be used. With Telma H potassium should be monitored.
5. AB Phylline must be taken as per your doctors advice.
Kind Regards
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Above answer was peer-reviewed by :
Dr. Kampana
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