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Quite often, to diagnose congestive cardiac failure you need an average good clinical skill. However, there are many patients in whom the diagnosis may become difficult; for example when a smoker having COPD develops dyspnoea, it may be due to ischaemic heart disease. Often, it may be difficult to pickup the same. In such situations, in Mumbai, we now have a blood test called brain natriuretic peptide (BNP), the levels of which are raised, if the patient has heart failure.
Though the test costs nearly Rs. 2000/-, it may be needed rarely. Unfortunately there are few tests to confirm congestive cardiac failure. Low Ejection Fraction seen on 2D Echocardiography can point towards the diagnosis. But there is no level of Ejection Fraction at which a CCF can be suspected/diagnosed, though a normal Ejection Fraction should be against the diagnosis of CCF most of the time. Secondly, the X-ray chest appearance can often help to diagnose left-sided heart failure. But in a COPD patient the X-ray chest may be confusing.
In most of the cases of CCF, BNP will certainly help. There is one more situation, where the patient has oedema of feet and the exact cause of oedema may at times be difficult to pinpoint. In such a situation, the BNP test can help you diagnose the cause of oedema.
CLINICAL UPDATE : INTRAVENOUS IRON FOR ANAEMIA
In our experience with more than 20000 doses of low-molecular-weight iron dextran, no serious adverse events have been observed and the test dose has not altered the therapeutic plan.
The role of intravenous iron in clinical medicine is poorly understood and is an underused tool in the treatment of iron deficiency and anaemia in chronic disease states. This underuse is at least in part due to misinformation and misinterpretation of the incidence and clinical nature of serious adverse events. When high-molecular-weight iron dextran is excluded, there is no substantially increased risk with the administration of intravenous iron.
Michael Auerbach, Harold Ballard, John Glaspy, The Lancet, 2007; 369 : 1502-4.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
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