In 2017 I was diagnosed with mild left ventricular diastolic disfunction and prescribed a beta blocker plus Losartan. I have recently had blood tests taken and my age related NT BnP is raised and my BNP is 430pg/mL. When seeing this, my GP referred me for an echocardiogram which was triaged by the Hospital and rejected on the very same day that they received it!!
I have recently had a very severe cough bringing up a lot of white frothy phelgm, was prescribed an antibiotic and predisolone for just five days which have helped. I saw my GP yesterday to find out why her referral was rejected and all she said was that it is because of my BMI of 42. I have an underactive Thyroid Gland, taking 125micrograms of Levothyroxine daily and I have lost about half a stone in weight. The GP's advice on this is that it is very hard to lose weight!!
Could someone please tell me how serious my BNP result is and how can I ensure that I receive the treatment that is needed to detect any further heart damage. I am almost 70 years old and do try to keep as active as possible. The GP just said that she can not do anymore for me!!
So my other question is, is the NHS now excluding anyone who has a high BMI from further investigations being carried out?
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theminiaturist
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Thank you for your quick response Cat04. My weight and BMI have remained constant now for 12 years, I have neither put weight on or lost any up until now. I had an echocardiogram in November 2017 plus another in April 2021 and they managed to acheive results then.
I don’t believe your BMI should stop you having an echocardiograph. I was on the NHS list but it was 6+weeks wait ( and during covid so that timeline was not guaranteed) and so I chose to go private because I am fortunate that I could afford it. I wanted clarity as to what I was dealing with. The cost was £150 and my BMI did not impact the quality of the scan.
My experience is NHS does restrict / delay some provision due to BMI because of likelihood of treatment not working / risk to patient; or third party providers to NHS have exclusions on service provision for higher BMI.
As others have suggested, talk to your GP about options
Hi, from thia exert, it seems your doctor acted properly;
2 Feb 2021The normal range for BNP is less than 100 pg/mL. High: More than 400 pg/mL Between 100-400 pg/mL requires a doctor's evaluation What Does a High BNP Mean? A BNP between 100-400 pg/mL may be considered a "gray zone," and a diagnosis depends on a careful physical examination and additional testing to determine the cause.
As to why the hospital rejected the doctors refferal I cannot even guess. I think that you are entitled to a reason for the rejection and should ask your doctor to inform you what was entered in your notes. Going by this extract, I think that you should definitely press for an explanation.
Although recent studies show that obesity, or elevated body mass index (BMI), is associated with lower levels of B-type natriuretic peptide (BNP), it is unknown whether BMI affects the prognostic value of BNP in heart failure (HF). This study confirms the relationship between high BMI and low BNP in patients with advanced systolic HF.
Having a high BMI certainly make it problematic to get clear imagery and affects interpritation. Unfortunately, and this is my own personal opinion, I am not a doctor. The cause of your heart failure very probably due to your high BMI, so if they got a good image, whta would they have advised? My thoughts are that they would tell you to lose weight. Is that, in effect what they advised after previous echocardiograms? I really do not know if there are alternative treatments, other than too lose the weight. Might you inquire as to how your doctor could help you in this endeavour? I have an enlarged heart, small vessel disease, atheriosis, and a past history of SVT's, atrial flutter, atrial fibrillation. I have had an irregular pulse of 308 bpm, a successful ablation has improved that. I can only wish you the best and hope that you find an answer.
hi my bNP was 180 now 485 but I haven’t been referred to a cardio doctor as I had a echo in July that showed I was ok yet my bNP had shot up any ideas ? I do have AF
I don't have enough knowledge for passing an opinion as I am not a doctor but it should be an automatic referral for a figure of 485 bNP? You are entitled to a second opinion regarding the decision not to refer you. Regarding your AF, is it, Paroxysmal AFib? These are episodes of AFib that occur occasionally and usually stop spontaneously. Episodes can last a few seconds, hours or a few days before stopping and returning to normal sinus rhythm, which is the heart's normal rhythm. Some people may have single episodes of AFib. You will shortly be able to refer yourself to specialists, don't know quite when! It may be an idea to ring the British Heart Foundation's helpline, 0300 330 3322. I cannot think of anything else at the moment, I'm afraid and only wish you the best.
Hi, high BNP levels are not always associated with your heart, levels can be elevated due to infections, a virus, diabetes etc. Your BNP level isn't particularly high did your GP rule out other possibilities before referring you for an echo? If antibiotics have helped with the white phlegm then that does sound like you've had an infection. my husband has heart failure & he also produces white frothy phlegm but as it's not pink tinged it's not considered an issue or even particularly heart related.
I'm really sorry but I don't know the answer to that question, you could phone the BHf nurses and ask them, the number is on this site somewhere. I dont know what my husband's current BNP level but in the past he had a level of 600 that went up to 1000 & whilst that sounds like a large increase it is in fact very minor & not something his cardiologist/GP/nurse was concerned about.
At the time of my appointment on Friday I didn’t actually have test result and tne cardiologist didn’t mention the bnp test score and not to I got a hard copy today did I see it . I am thinking did he have that info Friday or was it not of interest to him
We've often had appts when test results weren't available Do you have access to your cardiologists secretary? If we're unsure of anything we contact the secretary and she's great at finding out information for us.
I would request your doctor to give you a monitor over five days, that should settle the matter. If you don't agree with the doctor's decision, you are entitled to a second opinion. However an ablation is not always successful even for more than one ablation. I was very lucky and have had no real problems with AFib after my ablation. I am afraid I do not know how the doctors make up their mind as to whether you need an ablation or not. Again, the BHF maybe able to help .
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Worried about GP's couldn't care less attitude
What else causes heaviness on chest?
Requesting Copy of Hospital Records
Hospital update 
Failing Heart/Overactive Thyroid
