BNP

[green4sam]

What is the relationship of the BNP to the severity of heart failure?  Are there values that correlate to the four stages of heart failure?  Is it a marker that can used to follow over time to assess the efficacy of treatment?

I have heard that there is a new drug that is suppose to be released soon that is similar to amiodarone but without all the side effects.  Are you aware of this and what do you know about the drug.  I now have corneal deposits secondary to amiodarone so I am concerned.

I have also been told that there is a new oral anticoagulant that is suppose to have been available which only requires monthly labs or such but it hasn't been released yet?  Is there any new information on that drug?

How exactly does a low serum calcium affect heart function?  Does it affect rhythm and contraction etc.?

[CCF-M.D.-MJM]

Hi Sam,

Good questions....some don't have answers yet.

1. What is the relationship of the BNP to the severity of heart failure?

Higher BNP levels are usually associated with a worse acute exacerbation of heart failure, but does not help different the New York Heart Association classes of heart failure.  For example, a person with decompensated Class I heart failure may have an exceedingly high BNP while a compensated Class IV heart failure patient may have a normal BNP, despite the fact that Class IV CHF is worse than Class I.  There are subtleties to interpreting BNP that we are still working on.

I use BNP to help in patients where I am not sure if the symptoms are heart related or lung/deconditioning related.

3. Is it a marker that can used to follow over time to assess the efficacy of treatment?

Symptoms, history, and an occasional echo are best for this.  No lab test yet.

4. I have heard that there is a new drug that is suppose to be released soon that is similar to amiodarone but without all the side effects.

I have heard there is a new antiarrhythmic drug in the works, but I don't know the details about it.  I am slow to use new antiarrhythmic meds.  It is safer to wait and see how the post marketing research reflects on safety after it is released in wider populations.  What I am suggesting is that the studies to have a drug approved through the FDA don't always require a huge number of patients.  After the drug is released and used in more patients, it is not uncommon for new side effects or complications to appear over time.  The FDA requires drugs be followed over time after release incase such complications start appearing.   Case in point, your next question.....


5. I have also been told that there is a new oral anticoagulant that is suppose to have been available which only requires monthly labs or such but it hasn't been released yet? Is there any new information on that drug?

Ximelogatran was not approved by the FDA. They found dangerous liver toxicity and increased risk of MI in patients after surgery.  I do not think this drug will ever be released.

6. How exactly does a low serum calcium affect heart function? Does it affect rhythm and contraction etc.?

What matters is the serum-ionized calcium. If your ionized calcium is very low, it can make your heart contraction weaker.  The more important question is why is it low and what can be done to treat it.  Serum calcium is what is usually measured in lab tests and is a good surrogate for ionized calcium.  Low calcium can make you more prone to arrhythmia, especially if your potassium levels are high.

I hope this helps.

[uptowngirl]

Hi,
Just a quick question:  What exactly is BNP?
Thanks,
Uptown

[va_tony]

The BNP test measures the level of B-type Natriuretic Peptide in your blood stream. The ventricles make extra BNP when they can't pump enough blood to meet your body's needs. So if your BNP level is high, you probably have heart failure. The higher your BNP level is at diagnosis, the worse your heart failure is likely to be.   See for example, http://www.chfpatients.com/tests/bnp.htm

[uptowngirl]

Thanks Tony for the great explanation.  That gives me alot more insight in this post.  Have a great day.
Uptown

[Erik36]

The PVC questions have to stop! Almost every other question to the doctor is about PVC's. There is enough answers in the archives and just in the last week or so to tell any newcomer all they need to know about PVC's. Almost everyone who frequents this forum has PVC's and could answer any question there is about PVC's. I believe any questions about PVC's is a waste of a question.

[NBCT]

To erikthankgodyournotadoctor,
  I believe that any comment regarding someone's question being a wasted one, is just an annoyance to others who read it. Just wondering, what was your first question to this forum?????

[hankstar]

Erik , I have agreed with you on many occasions, but on this one , I'll just say not one question posted on this forum is a wasted question no matter of insignificant it may same to others here.

PVCs are one of the most common complaints related to the heart and by the way one of the most difficult to treat or reassure patients with this affliction, yes they are those that don't give them the time of the day, others can't, let's be more understanding and considerate to those who need reassurance every now and then, even if many consider a question about PVCs a wasted one.

There are some with PVCs, with symptoms which are so uncomforatble that they would probably trade them for a serious heart condition such cardiomyopathy with swollen ankles and feet, shortness of breath and the list goes on , but does not feel one PVC at all!! Think about it man !!!

Best regards,

[pms_barbie]

Well said hankstar....Again I say to anyone that doesnt want to hear about pvc's for gods sake dont read the post.  How simple is that? Eric look at it this way. Pvc's might not kill you neither would getting stung in the face a hundred times a day with a rubber band but it sure would get uncomfortable.

[Abeybaby]

I think its very unfair to anyone on this board to limit questions of any kind. I too often see ongoing questions on PVC's and wonder not why it was posted but how many sufferers there are world wide and why the medical and pharma community are still unable to deal with this chronic problem.  There are days when I get them I often go back to the archives searching for some reassurance that they wont kill me- this after having gotten more than 2000 in a day - enough to make one crazy.

I am sure the doctors too are tired of the questions but guess what maybe they should spend more time and money on this chronic problem ... because I am sure people who have cardiomyopathy w/ PVC's see the world very different from those who get them without disease. The issue is simple, I would rather not have them period!!!!!!!  But thats not the case and unfortunately many people get them and some very bad indeed.  There is always something to ask, something to learn from peoples postings and that's where I get my strength to keep on going. The doctors do a great job on the forum on the PVC questions but I would have to say that the collective information from patients is equally valid and important to me. So please keep the questions comming I am sure someone will identify real triggers and or provide a clue to this problem.

Have a wonderful holiday to everyone-

[Marilyn (runner)]

I'm sorry but I think anyone who tries to compare a PVC with 'open heart surgery' has never experienced open heart surgery or shocks from a defibrilator or full heart block or even a heart attack for that matter...  Let alone digesting 'rat' poison daily !!  

Millions of people die from heart disease every year and to even consider these two experiences are even closely related is a gross understatement.  

I don't care who you are - just try experiencing 32 jolts of electricity hitting your heart !!  and see if that feels the same as a pvc !!!  and I have no disrespect for pvc sufferers - but don't try and convince me the two are the same...  

Best Regards and CCF you don't have to threaten to ban me again from posting.  Consider this my last post..  

Happy Trails to all and to all a Good Night...  

Merry Christmas
Marilyn (runner)

[va_tony]

You asked about a new drug in development that's similar to amiodarone.  That's probably Dronedarone.  Like amiodarone it has multiple electrophysiologic actions but doesn't have have the thyroid or pulmonary problems that amiodarone does. It has a shorter half-life and can be loaded more easily than amiodarone. I understand that clinical trials are in progress.  The following URL discusses this and other new drugs that could be used to treat atrial fibrillation - - http://www.americanheart.org/presenter.jhtml?identifier=3003925 .

I was somewhat disappointed to read CCF-M.D.-MJM's remarks concerning Ximelogatran/exanta. I was eagerly looking forward to the release of this anticoagulant to the public so that I could stop taking coumadin and avoid the frequent PT-INR tests.  Looks like some of us will be stuck with coumadin the rest of our lives. What a bummer.

Tony

[DottyCece]

Marilyn,

I am not sure why they would ban you from posting...I guess I missed all that.  You are 100% correct.  PVCs are an annyoance in a heart with no disease and structurally okay.  There is absolutely no comparison to open heart surgeries of which I had two in 11 months, multiple cardioversions, ablations of all kinds, permanent pacemaker that sometimes paces everything inside me...worse than any PVC, heart failure..not being able to do the normal activities of daily living, difficulty getting the next breath, having an ICD etc. etc. all of this I have experienced in the course of 2 years.  I have had PVCs ever since I was diagnosed with cancer of the thyroid..had a number of cardiac procedures and was told it was probably related to the thyroid thing...I have lived very well with them for over 35 years..I was reassured nothing was wrong so life went on. They didn't have any relationship to the heart problems of the past two years.

Yes, I am sure people get anxious feeling their hearts doing funny things...yes it is uncomfortable. I been there....but believe me folks as one who had them and now one who has had so much more...THERE IS NO COMPARISON.  I say this with all humility and sincerity.  I just hate seeing and hearing people obssessing about something that is benign.

Take care all and enjoy life.  It is so fragile..never know when something of major consequence will strike you.

[hankstar]

There is no comparison between PVCs and serious heart disease, open heart surgery, ICD, shocks , pacemakers, dilated cardiomyopathy and the list goes on.

PVCs in general are "benign" and of no clinical signifinace even in persons with mild heart defects.

My heart goes out to anyone that suffer from those severe cardiac conditions, that basically you never know what will happen from one minute to the next, yet sometimes PVCs can be so symptomatic while persons with severe heart disease sometime have very little symptoms with respect to the severity of their disease, all I am saying for those that suffer with severe symptomatic PVCs, they would probabaly trade them in for "significant heart disease that doesn't cause significant symptoms, even though the PVCs are benign" that is not to say that PVCs are much more of a problem, it is really a "problem" that is not much of a "problem" at all medically speaking, but plays havoc with alot persons mentally.

If comments were insensitive to those who really have "significant" heart disease and have gone through horrible ordeals such as open heart surgerys, ICDs, shocks, etc. I sincerely apologise to you all. Once again my comments have been  misinterpreted and been taken out of context.

[pms_barbie]

You people sure dont read or understand very well at all.  Marilyn no one but no one copmpared a pvc to open heart surgery.  Seems like any time hankster post you blow it up and out of proportion.  You all still seem to overlook the fact some of us have other heart issues going on than pvcs.  You just have to let everyone know how bad you have it everytime you post.   Frankly it cant be all that bad if your running marathons.  May you continue to run marathons please just lay off the boards if the only thing you can do is nit pick what people say and stir the pot.

[hankstar]

Money and wealth don't mean one thing to me, we are all fighting a battle that we will lose one day (guaranteed), the battle of life.

One thing for certain right now, the doctor that can find a cure for PVCs will make alot more money than a cardiovascular surgeon, I could almost guarantee that for sure, yet the cardiovascular surgeon is much more needed doctor.

Think about that for a bit.

[jkf]

Well said! It seems as though Marilyn the runner can't talk enough about herself, yet doesn't like certain other very helpful people to voice their comments. I rarely comment on this board.  I do read it quite often and yes BECAUSE I am a PVC sufferer.  I also look for reassurance when mine start acting up.  It really helps.  And what is the big deal anyway.  Comments between fellow sufferers don't count as a question.  So noone looses their chance to post.

[pms_barbie]

Well I shouldnt have probably put it the way I did but I just get so tired of all the negative comments that she says.  If she has been through all that I truly feel sorry for her but I think I feel more sorry for her for always trying to be the center of attention.

[Erik36]

I have re-thought my post and I agree with you all. PVC's may not be of clinical significance but they are real to the person experiencing them. I was in that boat before. I respectfully withdraw my previous comment and thank all of you for your comments. My apologies!


Erik

[~*CaMeO*~]

I visit this board quite often, mainly on bad days when the PVC's start messing with my head ---- the reassurances from others riding in my boat is enough to calm an anxious mind and I thank you all for being free with your comments.  The board also provides some much needed laughter when I read how comments are strangly interpreted.  Lighten up people .......... life's too short to waste it on arguments and petty disagreements.  Work together, be kind and understanding, help the newbies with heart concerns .......... love you all!

[NBCT]

BRAVO!!!!