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What Does My Blood Test Report Indicate?
Posted on
Sat, 29 Jul 2017
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sat, 29 Jul 2017
Answered on
Thu, 24 Aug 2017
Last reviewed on
Question : I have been given very helpful answers on this site by 2 cardiologists.with my ECG on XXXXXXX 30. Using them I got an appointment with a private one, as it was hard to see one on the health service. He took my ECG, again on July 20 and he found more or less the same from that ecg,when I was felling well as the cardiologists on this website said based on a XXXXXXX 30 ecg, when I was feeling unwell. After that I have been given a blood test called Pro-BNP(GP) and will also have an echocardiograph. What does this blood test do? The private cardiologist wrote, based on an angiogram done in March 2016, then 2 of my coronary arteries are 50% blocked, and I have ischemia. How exactly am I supposed to interpret all these things? is being 50% blockec a :normal thing? What is ischemia? Are these readings of March 2016 not quite old? Sorry to bother, I hope you can clarify
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
Regarding your issues of concern I would explain as follows:
- NT-proBNP test is recommended to investigate for possible heart failure, which is a condition when the heart muscle doesn't contract or relax properly leading to difficulties in blood pumping and circulation. When this test is abnormally high, then heart failure is quite highly probable. The echocardiogram gives important clues for confirming this conclusion by clarifying the exact present cardiac structure and function abnormalities.
- Regarding cardiac ischemia, I would explain that it is a condition where the cardiac muscle is not properly (in fact insufficiently) supplied with blood flow due to certain blockages inside the coronary arteries.
- As two of your coronary arteries have resulted blocked around 50% about a year ago, this needs to be seriously considered.
In general a blockage needs to be around 75% or higher in order to produce clinically significant symptomatology and complications including chest pain, cardiac ischemia and even myocardial infarction. That's why the doctors have referred insignificant problems (*normal*) with your heart that time.
Nevertheless, it is not rare when even a 50% stenosis has led to the above mentioned complications. In order to properly define the importance of those 50% coronary blockages any of the following tests could be helpful:
- nuclear perfusional stress test,
- coronary Fractional Flow Reserve (FFR- in fact it is performed during coronary angiography)
In general it is supposed that those 50% coronary stenoses may have even grown further after a year an more. That's why it is recommended to seriously consider a close follow up and further investigations, in order to avoid the above mentioned complications.
Hope to have clarified your uncertainties!
In case you have any further questions, do not hesitate to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
Regarding your issues of concern I would explain as follows:
- NT-proBNP test is recommended to investigate for possible heart failure, which is a condition when the heart muscle doesn't contract or relax properly leading to difficulties in blood pumping and circulation. When this test is abnormally high, then heart failure is quite highly probable. The echocardiogram gives important clues for confirming this conclusion by clarifying the exact present cardiac structure and function abnormalities.
- Regarding cardiac ischemia, I would explain that it is a condition where the cardiac muscle is not properly (in fact insufficiently) supplied with blood flow due to certain blockages inside the coronary arteries.
- As two of your coronary arteries have resulted blocked around 50% about a year ago, this needs to be seriously considered.
In general a blockage needs to be around 75% or higher in order to produce clinically significant symptomatology and complications including chest pain, cardiac ischemia and even myocardial infarction. That's why the doctors have referred insignificant problems (*normal*) with your heart that time.
Nevertheless, it is not rare when even a 50% stenosis has led to the above mentioned complications. In order to properly define the importance of those 50% coronary blockages any of the following tests could be helpful:
- nuclear perfusional stress test,
- coronary Fractional Flow Reserve (FFR- in fact it is performed during coronary angiography)
In general it is supposed that those 50% coronary stenoses may have even grown further after a year an more. That's why it is recommended to seriously consider a close follow up and further investigations, in order to avoid the above mentioned complications.
Hope to have clarified your uncertainties!
In case you have any further questions, do not hesitate to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much Dr Sharka, it is really important for patients to get full information!
What values should we have on the BNP test to be normal/abnormal? They usually give the results with a value range next to it, to give us an idea,but even so, that is not a enough for people who are not medical to judge these things.
I have been feeling better for the last 10 days, and am going about normal activities walking and using the train. I was going thru hell for some time.Could it have gotten better?
You see my results about the stenoses-which I assume means narrowing,which are 18 months old,March 2016 the doctors kept it secret from me and even said my chest pains were psychological which I knew was untrue. I changed to a better doctor in April 2017 which is when i was told about the old result. I feel they won't give accurate information over here, which is probably their policy. People want to know really which is why this is so helpful
That old report,it seems said the narrowing is in side branches not main branches, they were almost 50% in the OM and diagonal branches, and 30% in some. I assume there are lots of branches of arteries.
Well in September 2016 and April 2017 they put me through the same kind of machine that has a donut shaped spinning device into which your body gets moved. But unlike their first test, they did not inject a XXXXXXX and it took a second.
They said it was for the lung which was normal. What are these tests called, if the first one was a CT Angiogram? If they took a picture of the lung did it also show the heart? What I mean is can they see the heart and arteries and whatever on those pictures which were not looked at? Finally does the echocardiogram show the narrowing? I will have mine on Monday
The another ECG on July 20, (recent) the cardiologist ( I saw someone privately as I could not see one on rhe NHS) said something like "q waves in lead III and avf". He said it was bad news if I were a man, but in women, these things come and go for no apparent reason. He then looked at my March 2016 ecg and wrote no tests needed unless chest pain persists,because the stenosis is short of 50% in side branches, and unless there is severe ischemia-something like that. So he thinks I have some ischemia?
I have been feeling better for about 10 days and my breathing is comfortable after a long time-I dont know why but have changed my diet to a healthier one. I still have a twinge of pain come and go in the same spot, like something moving through, -and my BP -systolic I think is between 140-155 all the time,
I have on the whole been healthy till now. I suppose it is better to know and take precautions, than to get one massive attack without warning? I get elated when I feel better and down when I start having pains.
I don't know how to thank you enough
What values should we have on the BNP test to be normal/abnormal? They usually give the results with a value range next to it, to give us an idea,but even so, that is not a enough for people who are not medical to judge these things.
I have been feeling better for the last 10 days, and am going about normal activities walking and using the train. I was going thru hell for some time.Could it have gotten better?
You see my results about the stenoses-which I assume means narrowing,which are 18 months old,March 2016 the doctors kept it secret from me and even said my chest pains were psychological which I knew was untrue. I changed to a better doctor in April 2017 which is when i was told about the old result. I feel they won't give accurate information over here, which is probably their policy. People want to know really which is why this is so helpful
That old report,it seems said the narrowing is in side branches not main branches, they were almost 50% in the OM and diagonal branches, and 30% in some. I assume there are lots of branches of arteries.
Well in September 2016 and April 2017 they put me through the same kind of machine that has a donut shaped spinning device into which your body gets moved. But unlike their first test, they did not inject a XXXXXXX and it took a second.
They said it was for the lung which was normal. What are these tests called, if the first one was a CT Angiogram? If they took a picture of the lung did it also show the heart? What I mean is can they see the heart and arteries and whatever on those pictures which were not looked at? Finally does the echocardiogram show the narrowing? I will have mine on Monday
The another ECG on July 20, (recent) the cardiologist ( I saw someone privately as I could not see one on rhe NHS) said something like "q waves in lead III and avf". He said it was bad news if I were a man, but in women, these things come and go for no apparent reason. He then looked at my March 2016 ecg and wrote no tests needed unless chest pain persists,because the stenosis is short of 50% in side branches, and unless there is severe ischemia-something like that. So he thinks I have some ischemia?
I have been feeling better for about 10 days and my breathing is comfortable after a long time-I dont know why but have changed my diet to a healthier one. I still have a twinge of pain come and go in the same spot, like something moving through, -and my BP -systolic I think is between 140-155 all the time,
I have on the whole been healthy till now. I suppose it is better to know and take precautions, than to get one massive attack without warning? I get elated when I feel better and down when I start having pains.
I don't know how to thank you enough
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
It is true that when discussing about natriuretic peptides some confusions may arise.
Different upper limit values are applied if several markers are used (BNP or NT-proBNP, MR-proANP), different normal values are considered whether we are judging an acute or non-acute cardiac condition.
In addition, certain health disorders and conditions like atrial fibrillation, renal failure, advance age and even body weight (obesity) have direct implication in shifting the normal cut off points when considering natriuretic peptides.
That’s why it is necessary a comprehensive evaluation of clinical and laboratory correlates by the attending physician when investigating the utility of natriuretic peptides as markers of heart failure.
Now returning to your coronary artery stenoses, it is true that subclinical branch lesions may seem to be more benign; giving a lower burden of complications and also clinical symptomatology.
Nevertheless, with the progression of coronary stenoses with time they may become more aggressive and dangerous leading to myocardial damage, life-threatening arrhythmias, heart failure.
That’s why it is important a close clinical follow up and repeated medical tests.
Echocardiography is not able to detect coronary stenosis or their progression; it may be helpful to detect clinical complications instead.
Tests to be considered appropriate in this regard would be nuclear perfusional cardiac stress test, evaluation of fractional flow reserve (FFR), dobutamine cardiac stress echo.
This would help to confirm or exclude possible cardiac ischemia evidence.
Meanwhile, chest CT (without contrast) may be helpful at studying structural pulmonary changes but not coronary artery disease.
As the coronary lesions are moderate, it is necessary to follow a healthy life-style, diet and treatment.
A Mediterranean diet style, frequent daily physical activities, controlling body weight and blood pressure values, improving blood lipid profile, avoiding smoking contacts would be beneficial.
Statins treatment is encouraged but hormone replacement therapy offers no additional cardiovascular protection.
In conclusions, a close periodic follow-up program with the cardiologist is very important at depicting the right time for introducing each of the above mentioned interventions.
Hope to have been helpful to you!
Wishing you are having a pleasant weekend!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
It is true that when discussing about natriuretic peptides some confusions may arise.
Different upper limit values are applied if several markers are used (BNP or NT-proBNP, MR-proANP), different normal values are considered whether we are judging an acute or non-acute cardiac condition.
In addition, certain health disorders and conditions like atrial fibrillation, renal failure, advance age and even body weight (obesity) have direct implication in shifting the normal cut off points when considering natriuretic peptides.
That’s why it is necessary a comprehensive evaluation of clinical and laboratory correlates by the attending physician when investigating the utility of natriuretic peptides as markers of heart failure.
Now returning to your coronary artery stenoses, it is true that subclinical branch lesions may seem to be more benign; giving a lower burden of complications and also clinical symptomatology.
Nevertheless, with the progression of coronary stenoses with time they may become more aggressive and dangerous leading to myocardial damage, life-threatening arrhythmias, heart failure.
That’s why it is important a close clinical follow up and repeated medical tests.
Echocardiography is not able to detect coronary stenosis or their progression; it may be helpful to detect clinical complications instead.
Tests to be considered appropriate in this regard would be nuclear perfusional cardiac stress test, evaluation of fractional flow reserve (FFR), dobutamine cardiac stress echo.
This would help to confirm or exclude possible cardiac ischemia evidence.
Meanwhile, chest CT (without contrast) may be helpful at studying structural pulmonary changes but not coronary artery disease.
As the coronary lesions are moderate, it is necessary to follow a healthy life-style, diet and treatment.
A Mediterranean diet style, frequent daily physical activities, controlling body weight and blood pressure values, improving blood lipid profile, avoiding smoking contacts would be beneficial.
Statins treatment is encouraged but hormone replacement therapy offers no additional cardiovascular protection.
In conclusions, a close periodic follow-up program with the cardiologist is very important at depicting the right time for introducing each of the above mentioned interventions.
Hope to have been helpful to you!
Wishing you are having a pleasant weekend!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Wow, thanks. I will naturally print your info and keep safely. You have answered all my questions. Re markers, these are all different markers right? Are they supposed to. do they use more than 1 marker? Mine was Pro-BNP(GP). I assume you would recognize this marker. What do you think of it, and what would you say the readings should be? It is better for me to discontinue HRT?
No one told me to use HRT but I asked the doctor to give it. Is there a substitute for HRT which would be better? Could I have too much oestrogen due to taking tablets, which is not good for the heart? Should I double my dose or have HRT with progesterone? Obviously this may not be an appropriate question to ask a cardiologist, but I have been on HRT from 2012 approx., and of my own volition, for 2 years I managed get it without a doctors prescription but the rules have become stricter now. . sorry if this is not the type of question you answer.
Anyhow you have clarified the echo cardio gram wont measure stenosis and the lung tests wont. You have said the stenosis may get worse with time, therefore I need periodic checkups. You did not say though I should repeat the CT angiogram of March 2016 to re check the stenosis?
I know all this is a doctors job but many people feel they want some control esp my BP was showing as 145 and he said your BP is excellent. I don't completely trust them over here in the UK
Also I am vegetarian by preference, so can I still eat a Mediterranean diet? I eat pizza regularly.
What is your view of "Q waves in lead III with AVF"? Do you agree it is bad news in a man but with women it could be all sorts of things? Meaning it could be the same as a man. I am 65 Kg and 159 cms-is that obese by definition and can an abnormality be considered more normal because someone is obese? Am I by medical definition obese-I will be 59 soon so I mean I look slimmer than the majority of women my age. I am sure these are open to interpretation and will take yours as a particularly learned / expert opinion.
If I had "low voltages QRS in pre cordial leads" on XXXXXXX 30 when feeling lots of chest pain and "Q waves in lead III with AVF" on July 20th when feeling much better, does that give you a suspected diagnosis. If I get a suspected diagnosis from you I will take it to my GP and ask him to give me a written one, what his findings are. My cough has returned and my legs give me hell now and then,
Based on your advice, you have not suggested repeating the CT angiogram (please explain) but you did feel I should have follow ups once every 3 or 6 months with a cardiologist?
I don't want to have a complaining attitude about my ailments, as you are very patient and thorough answerer of questions
No one told me to use HRT but I asked the doctor to give it. Is there a substitute for HRT which would be better? Could I have too much oestrogen due to taking tablets, which is not good for the heart? Should I double my dose or have HRT with progesterone? Obviously this may not be an appropriate question to ask a cardiologist, but I have been on HRT from 2012 approx., and of my own volition, for 2 years I managed get it without a doctors prescription but the rules have become stricter now. . sorry if this is not the type of question you answer.
Anyhow you have clarified the echo cardio gram wont measure stenosis and the lung tests wont. You have said the stenosis may get worse with time, therefore I need periodic checkups. You did not say though I should repeat the CT angiogram of March 2016 to re check the stenosis?
I know all this is a doctors job but many people feel they want some control esp my BP was showing as 145 and he said your BP is excellent. I don't completely trust them over here in the UK
Also I am vegetarian by preference, so can I still eat a Mediterranean diet? I eat pizza regularly.
What is your view of "Q waves in lead III with AVF"? Do you agree it is bad news in a man but with women it could be all sorts of things? Meaning it could be the same as a man. I am 65 Kg and 159 cms-is that obese by definition and can an abnormality be considered more normal because someone is obese? Am I by medical definition obese-I will be 59 soon so I mean I look slimmer than the majority of women my age. I am sure these are open to interpretation and will take yours as a particularly learned / expert opinion.
If I had "low voltages QRS in pre cordial leads" on XXXXXXX 30 when feeling lots of chest pain and "Q waves in lead III with AVF" on July 20th when feeling much better, does that give you a suspected diagnosis. If I get a suspected diagnosis from you I will take it to my GP and ask him to give me a written one, what his findings are. My cough has returned and my legs give me hell now and then,
Based on your advice, you have not suggested repeating the CT angiogram (please explain) but you did feel I should have follow ups once every 3 or 6 months with a cardiologist?
I don't want to have a complaining attitude about my ailments, as you are very patient and thorough answerer of questions
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
I understand your concern and would not recommend performing a coronary angio CT scan for two reasons:
a- It is not a sensitive test for small coronary vessels and the distal branches of the coronary arteries and I would not consider it the best test option in your clinical situation.
b- It has a lot of radiation compared to the other tests.
For this reason, I would recommend performing the above mentioned tests instead of coronary angio CT scan in order to investigate for coronary artery disease:
-nuclear perfusional cardiac stress test
-evaluation of fractional flow reserve (FFR), dobutamine cardiac stress echo.
These tests would help also clarify your ECG changes.
Of course a coronary angiogram would be the golden standard test to examine your coronary arteries and specify the degree of stenosis in them, but it is invasive and has some degree of radiation too.
Regarding HRT, I would not recommend taking it any more. You should know that many studies have shown that it has no benefits at women of your age and in addition it increased your cardio-vascular risk and the risk for uterine and breast cancer.
So, I would strongly encourage you to stop taking it. There is no substitute to this therapy.
I would also advice continue with Mediterranean Diet, which is a really healthy diet, helpful in decreasing your cardiovascular risk.
Regarding cardiac markers, NT-pro BNP is a good marker for heart failure. As I explained to you above its values are based on the age, renal function and other individual parameters.
But generally for ages 50-75 years old values < 300 pg/mL are considered normal.
Anyway, NT-proBNP levels should be interpreted by your cardiologist based also on your cardiac ultrasound findings.
You should discuss with your doctor on the above issues.
Hope to have clarified some of your uncertainties!
Wishing all the best,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
I understand your concern and would not recommend performing a coronary angio CT scan for two reasons:
a- It is not a sensitive test for small coronary vessels and the distal branches of the coronary arteries and I would not consider it the best test option in your clinical situation.
b- It has a lot of radiation compared to the other tests.
For this reason, I would recommend performing the above mentioned tests instead of coronary angio CT scan in order to investigate for coronary artery disease:
-nuclear perfusional cardiac stress test
-evaluation of fractional flow reserve (FFR), dobutamine cardiac stress echo.
These tests would help also clarify your ECG changes.
Of course a coronary angiogram would be the golden standard test to examine your coronary arteries and specify the degree of stenosis in them, but it is invasive and has some degree of radiation too.
Regarding HRT, I would not recommend taking it any more. You should know that many studies have shown that it has no benefits at women of your age and in addition it increased your cardio-vascular risk and the risk for uterine and breast cancer.
So, I would strongly encourage you to stop taking it. There is no substitute to this therapy.
I would also advice continue with Mediterranean Diet, which is a really healthy diet, helpful in decreasing your cardiovascular risk.
Regarding cardiac markers, NT-pro BNP is a good marker for heart failure. As I explained to you above its values are based on the age, renal function and other individual parameters.
But generally for ages 50-75 years old values < 300 pg/mL are considered normal.
Anyway, NT-proBNP levels should be interpreted by your cardiologist based also on your cardiac ultrasound findings.
You should discuss with your doctor on the above issues.
Hope to have clarified some of your uncertainties!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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