Acute vs. chronic heart failure

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The distinction between acute and chronic heart failure can be an important one from a clinical standpoint, but is not always clear from the history, physical exam, and echocardiogram. A rapid way of detecting acute left ventricular dysfunction would be useful. Fried et al evaluated N terminal proB-type natriuretic peptide levels as a method for distinguishing acute versus chronic left ventricular dysfunction. They found that levels of this natriuretic peptide were elevated in patients with acute heart failure compared to those with more chronic heart failure. With serial measurements, the level declined over time in those with acute heart failure. Future studies should be directed at evaluating the utility of this test in a clinical setting.