Cardiac Failure

Valerie Schroeder
Laboratory Assessment of Heart Failure
Laboratory testing helps to support a heart failure diagnosis. Chest x-rays may reveal cardiomegaly or pulmonary congestion and help to track responses to therapy. Echocardiograms may reveal the underlying cause and the degree of myocardial dysfunction. EKG’s assess rhythm disturbances or ischemia but are less helpful for other diagnoses. Biomarkers such as serum brain type natriuretic peptide (BNP) are commonly used to assess the presence and severity of heart failure. In acute heart failure, a BNP level> 500pg/ml has a 90% predictive value for the presence of heart failure and levels <100 pg/ml have a 90% predictive value for the absence of heart failure. Cardiac MRI can be used to distinguish between myocarditis and ischemic heart disease as well as assessing cardiac chamber size and function (3, 5, 6).

Echocardiography remains the gold standard assessment for left heart function in children. In general, an ejection fraction (EF) <50% is usually considered abnormal. An EF of 40-50% is considered mid-range dysfunction whereas and EF <35-40% is considered more severe. The latter EF range is the key range used pediatric therapeutic clinical trials and forms the basis for many treatment options used today. Echocardiography is less accurate at assessing right ventricular dysfunction whereas cardiac MRI can assess either ventricle. Diastolic dysfunction is usually an echo diagnosis. However, the criteria for children are less clear as diastolic function also changes with age (10-13). Newer echocardiography guidelines for assessment of cardiac dysfunction are pending for 2016.

Cardiac Failure Cardiac Failure 05/11/2016
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