NT-proBNP testing in primary assessment
In studies of chronic unexplained shortness of breath, the addition of BNP testing has improved diagnostic accuracy and time to diagnosis for cardiomyopathy related disease1.
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Patient with unexplained shortness of breath
(> 4 weeks duration)
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Patient with unexplained shortness of breath
This algorithm provides recommended primary, secondary and tertiary investigations in the diagnostic workup of patients with chronic unexplained shortness of breath with clinical judgement recommended at each step1.
Clinical Assessment
(History and physical examination)
Clinical Assessment
The best predictors of heart failure are clinical findings that reflect severe decompensated disease, whilst early clinical diagnosis is more challenging1.
Primary Investigations1
Primary Investigations1
Natriuretic peptide testing is recommended in many heart failure guidelines as a first line test in the diagnosis of heart failure and has been reported as a less expensive and more accessible diagnostic test for heart failure than echocardiography1.
Diagnosis not evident: Specialist referral
Secondary Investigations1
Secondary Investigations1
After initial investigations, clinicians may consider further specialised investigations or referral to a specialist in tertiary care with a view to additional specialised testing1.
Diagnosis not evident: Further referral
Tertiary Investigations1
Tertiary Investigations1
Imaging: cardiac MRI, lung ventilation/perfusion (V/Q) scans, myocardial perfusion scans, stress echocardiogram or CT coronary angiography. More invasive testing: cardiac catheterisation for assessment of coronary artery disease or pulmonary pressures, muscle biopsy, bronchoscopy or surgical lung biopsy1.
Diagnosis not evident
Other considerations
Consider:
- Further specialist consultation
- Obesity and/or deconditioning
- Trial re-conditioning exercise program for 3 months with re-evaluation at 6 months
- Psychogenic causes
Adapted from Ferry, et al (2019).
References
*BNP and NT-proBNP biomarkers can be used BNP: B-type natriuretic peptide; CT: computed tomography; ECG: electrocardiogram; FBC: full blood count; NT-proBNP: N- terminal pro B-type natriuretic peptide; RFT: respiratory function test; TFT: thyroid function test.
- Ferry OR, et al .J Thorac Dis 2019; 11: S2117-S2128.
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