A 60 year old man came into the office complaining of abdominal bloating and gas. He also had intermittent shortness of breath and a vague shoulder discomfort. He said that Pepto-Bismol made him feel better. There was a prior history of heart attack several years before. His blood pressure was normal and his pulse was not increased. His electrocardiogram (EKG) revealed evidence of old cardiac damage from the prior heart attack, but no new cardiac event.
Because of his history of heart problems I ordered an immediate BNP (B type natriuretic hormone) blood test, even though it seemed like his problem was intestinal. Our lab can run this test in 10 minutes. The BNP was elevated at 200 (normal less than 100). He went to the hospital, where other studies indicated a heart attack, and he was admitted. Without the BNP test, this patient would certainly have gone home, since his symptoms did not suggest a heart problem. He was much safer in the hospital, where he could be treated, and monitored for complications.
BNP is a hormone produced by the heart muscle in increasing amounts when the heart is under stress, such as during a heart attack or heart failure. The test should be available in more private offices, as the machine to run it is relatively inexpensive and very easy to use. BNP can be followed as an indicator of cardiac muscle strength. If it is normal, it is likely that a patient with chest pain is not having a heart attack.
If you want to clarify your cardiac status, especially if you are having chest discomfort, request a stat (immediate) BNP. It could save your life.
Allan Sosin, MD