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Thursday, 5 May 2016

Acute shortness of breath and wheezy chest

A 56-year-old man presented to the emergency department with acute shortness of breath and wheezing. He had no chest pain.

His pulse rate was 121 beats per minute with normal volume and regular rhythm. Blood pressure was 110/60, respiratory rate was 22 per minute, and temperature was 37.3 C.

Chest auscultation revealed mild ronchi, while examination of the heart was normal.
ECG and chest x-ray were normal.

Which one of the following statements is true?

A- High serum BNP will not change the management decision of this patient

B- High serum BNP excludes heart failure

C- Low serum BNP suggests non-cardiac etiology

D- High serum BNP is of better prognostic value than high serum NT-proBNP

E- Elevated serum BNP is of higher diagnostic value than elevated serum NT-proBNP


  1. BNP
    Is good for excluding CHF
    But if it's high there are wide DD

    1. Exactly! It's of high negative predictive value especially in the absence of typical symptoms of heart failure (good for triage).
      On the other hand, when it's raised, although highly sensitive for heart failure, it's less specific and can be seen in COPD and elderly people, and probably more.