Laboratory tests

Chemical "biomarkers" in the blood help flag a condition or indicate how it is progressing. With heart failure, physicians generally look at several biomarkers, especially if a patient has known heart disease. Patients with higher than normal levels of one or more key biomarkers have been shown to have a far higher risk of developing congestive heart failure or of dying from heart disease than do individuals whose levels are normal.

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The following lists typical blood tests and identifies the biomarkers of interest.

• Lipid blood tests: Measures the amount of LDL (the bad cholesterol), HDL (the good cholesterol), and triglycerides, another fatty substance. You can learn more about this test at our lipid blood tests page.
• Enzymes: When heart cells are damaged, several enzymes are released. These include creatine kinase (look for CK on the lab printout), creatine phosphokinase (CPK), lactic dehydrogenase (LD or LDH), troponin, and myoglobin. You can learn more about this test at our enzymes page.
• C-reactive protein (CRP): Indicates the presence of inflammation, which may in turn contribute to heart attacks, stroke, and other cardiovascular problems. You can learn more about this test at our C-reactive protein page.
• Homocysteine: High levels of homocysteine are now considered by many physicians to be an independent predictor of heart disease. (Supplemental folic acid and vitamins B12 and B6 almost always bring high homocysteine down to normal.) You can learn more about this test at our homocysteine page.
• Electrolytes: Primarily sodium and potassium, to be sure that too much or too little sodium or potassium is not causing heart symptoms. You can learn more about this test at our electrolytes page.
• BNP: When heart failure occurs or worsens, the pumping chambers, or ventricles, produce a substance that breaks down to form two proteins: B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP). Both BNP and NT-pro-BNP are secreted into the bloodstream, and their levels rise when heart failure symptoms worsen and fall when symptoms improve. In recent tests, patients who had an elevated level of either protein had a higher risk of death and illness from heart failure. BNP and NT-pro-BNP help determine if you have heart failure rather than another condition that may cause similar symptoms. They also can help the doctor determine if your heart failure has worsened, meaning that more aggressive treatments are needed. Which test your doctor orders (i.e., BNP or NT-pro-BNP) depends on what is available at that medical center. Both tests have been shown to be beneficial.
• Kidney function: Creatinine and blood urea nitrogen (BUN). If the creatinine blood test raises questions, a urinalysis for creatinine will confirm how well the kidneys are working.
• Thyroid function: An overactive thyroid gland—hyperthyroidism—can produce symptoms resembling those of heart failure, so checking the function of the thyroid gland is important.
• Hemoglobin: An oxygen-containing substance carried by the red cells.