Heart & Cardiology/ProBPN

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Question
Dear Dr Ahmed
My husband is 66 and suffers from chronic kidney disease and hypertension.  His eGFR is 19 and steadily declining. He had two stents put into the arteries to his heart about a year ago but is still very breathless and tired.  He has not had any real workup on his heart and it is worrying me because neither his Nephrologist nor his General Practitioner seem concerned.  The Cardiologist put in the stents during an angiogram but never saw him before that or after the procedure.  He was not even told when to go back for a check up. He had a ProBPN blood test done last year and the result was high - 762pg/ml.  Our laboratory's reference range is 125pg/ml. I am worried but maybe you think I am overreacting?

Answer
Hi Rosemary, http://myheart.net/articles/

Your husband has several conditions which can worsen his cardiovascular condition and that need close attention, such as ckd, hypertension and known coronary disease. The signs and symptoms you mention are suggestive of heart failure, this is backed up by an elevated BNP, although BNP elevation in renal disease may be non specific. He had stents placed a year ago and still has symptoms that are concerning.

I would suggest the following.see a cardiologist, and specifically ask, be assesses clinically for heart failure ands whether he has excess fluid on board, what is his heart pumping function (LVEF) and if down i would ensure he is on an optimal medical regimen. If his symptoms have declined there may also be a role for assessment of coronary disease, although given his kidney function avoidance of further dye for procedures is ideally avoided if possible. One other important consideration could be fluid retention given the severity of the kidney disease, a renal Dr should be seen also to ensure optimal management, fluid removal in the form of diuresis and one day dialysis may be needed to improve symptoms. If you are able see these specialists and ensure all the above issues are being covered.

Hope that was helpful.

Heart & Cardiology

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Mustafa Ahmed MD

Expertise

Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease

Experience

Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology

Organizations
http://blog.myheart.net

Publications
Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

Education/Credentials
MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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