Right heart failure laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jad Z Al Danaf; Rim Halaby

Laboratory tests are useless in the diagnosis of heart failure, however they are essential in identifying possible precipitating factors of decompensation, assessing severity of the heart failure, monitoring the side effects of medical treatment and some serve as prognostic markers.^[1] In addition, in patients with right heart failure, an arterial blood gas can be useful in assessing the degree of hypoxemia. This can in turn be used to guide therapy with oxygen.

• Anemia might trigger decompensation of heart failure.
• Low lymphocyte >7000/µL basal white blood cell count and ESR >15mm in first hour might indicate worse prognosis
• CBC is to be repeated every 6 months unless needed to be repeated more frequently.

• Hypernatremia, increase in serum creatinine and hypokalemia might result from aggressive diuretic therapy.
• Hypokalemia and hypomagnesemia as side effects of potassium-losing diuretics.
• Hyperkalemia secondary to renal failure, excessive potassium intake or as a side effect of diuretics (ACR-I, ARB and spironolactone)
• Target range for K+ should be 4-5 mEq/L
• To be repeated daily to adjust dose of diuretics and then every 2-3 months in stable patients.

• Hyperuricemia can be seen in renal failure and secondary to thiazide diuretic use. It is also seen in cachectic patients.
• It is to be repeated every 6 months in stable patients and 3 months in patients on high diuretic doses.

• Elevated alkaline phosphatase, liver transaminases and total bilirubin can be secondary to liver congestion.
• Elevated gamma glutamyl transferase values are sensitive but nonspecific indicators of heart failure.
• Hypoalbuminemia can be seen in malnutrition or renal dysfunction. It also raises the suspicion of protein losing enteropathy which necessitates checking stool alpha 1-antitrypsin.
• It is to be repeated every 6-12 months in stable patients, during every heart failure decompensatory episode and in pathological weight loss.

• INR especially during anticoagulant therapy or in setting of hepatic dysfunction-nutmeg liver must be measured.

• Highly sensitive troponin I (hs-cTnI) serves as outcome predictors with more sensitivity then cardiac troponin T (cTnT).

• Thyroid hormones must be measured in cases of atrial fibrillation, dilated cardiomyopathy, patient on amiodarone therapy and in patients older than 65 years of age.
• Blood glucose level in non-diabetics
• High blood glucose level in non-diabetic patients can be secondarily to high diuretic doses such as thiazides.

• B-type natriuretic peptide (BNP) and NT-proBNP
• Endothelin-1
• Miscellaneous (Plasma renin activity, ANP, NE, hsCRP, calitonin gene related peptide, prostaglandins, erythropoietin)^[3][4][5][6]

Shown below is a table summarizing the interpretation of the levels of BNP and NT-proBNP levels.

Template:WH Template:WS