Serum brain natriuretic peptide level in a patient with chronic obstructive pulmonary disease and chronic heart failure.

Abstract

A 52-year-old woman with chronic obstructive pulmonary disease (COPD) and chronic heart failure presented in respiratory distress. Physical examination could not differentiate COPD exacerbation from chronic heart failure decompensation. As her serum B-type natriuretic peptide level was 1030 pg/mL, she was initially treated for chronic heart failure decompensation. Serum B-type natriuretic peptide level fell to 308 pg/mL, but respiratory distress persisted. She was then treated with intravenous solumedrol for COPD exacerbation. Respiratory distress rapidly resolved. Serum B-type natriuretic peptide level is useful to detect heart failure in the presence of COPD but does not substitute for clinical judgment to initiate proper management.