Heart test NT-pro BNP cost and need.

[sapson]

Two days ago woke up at 3AM pouring sweat with a fast and highly irregular heartbeat and high bp. At 7am it was still skipping jumping and my pulse oximeter could hardly get a reading. Sweating only lasted 45 minutes and no chest pain, however with BP still high 165/110 pulse 115  and arrhythmia symbol on BP monitor .and totally irregular pulse all whilst laying down continuing...... I went to the heart hospital Queen Sirkit kku.

 

This place at 8am has turned into an incredible crowd scene the Premium clinic previously tranquil was now packed to rafters no seats total mayhem in the morning be warned and no doc after 11-am.

 

Eventually given ECG in ER showing HR 132BPM  and this my first abnormal ECG was AFIB . referred back to premium clinic mayhem area for blood tests, 3 hours later test results showed TroponinT was 15 ngl just over the upper normal limit, last test year ago 7.9 .

 

Incredibly rushed Doc referred me back to ER and seemed not interested maybe because of lack of chest pain, however another doc took over and suggested instead of ER, go home come back in two days at regular evening clinic repeat Ecg and Troponin T, chest Xray and suggested doing a NT-pro BNP test., which I am wondering is this the gold standard heart blood test and how much it would cost roughly?

 

Also with a repeat trop T test 2 days on is it best that decreases dramatically or slightly ? obviously hoping for a ECG normal this time if not and still AFIB i will have to accept the offer of de- coagulants he prescribed  Xarelto at 95 baht a day must be a cheaper alternative Warfarin?

 

Thanks for any input.

 

 

 

 

Edited June 13, 2023 by sapson

[Sheryl]

  Warfarin is indeed a cheaper option but has a very narrow therapeutic range so higher risk of bleeding episodes and requires regular monitoring through frequent blood tests.

 

NT-probnp test helps determine if you are in heart failure and if so how severe.  I have no idea what they would charge for it. Combination of clinical findings, chest Xray and maybe   echocardiogram are usually sufficient to diagnose heart failure so if the test turns out to be costly you could ask the doctor if really essential/how likely is it to alter the treatment plan. 

 

With Troponin T import thing is that it be back in normal range. Exactly where in that range does not matter.  However if you are in heart failure a slight elevation may remain. 

 

You do not mention it but I trust they gave you something to lower your heart rate? Heart failure in a-fib results from thd ventricles going too fast in an effort to keep up with the atria. It is important to control that and usually possible with medication. 

 

[sapson]

Thanks Sheryl.

 

With the AFIB ecg and raised trop t should they have kept me there and done more tests at the time.? Im 64 Diabetic very skinny for my build and height with hba1c just checked 6.1. but when i get a cut very slow to heal so concerned about anti- coagulant thinner guess a balancing act.

 

Offered some medication to bring heart rate down but with my previous normal heart history of a low bradycardia, concerning that it would drop to low if heart naturally resets itself. Waitng till this evenings appointment .

 

My normal resting sitting hr about 65 bpm and a hours slow walk HR hovers around 95 TO 105 bpm.

 

Since Tuesdays early morning incident now resting sitting, up a tad to 80 bpm and moving about cleaning going to shop around 105 ... so ok, although elevated for me, however pulse has been regular the main concern.

 

My CBC normal but electrolyte potassium was low 3.1 given the XLc to bring it up.

 

Was already under such enormous stress anxiety at the moment getting ready to finally leave for Uk, could this acute level of stress cause the AFIB and Trop t elevation, I dont want to under or over react to this heart situation.

 

Thanks as always for your kind advice,

 

 

 

 

[Sheryl]

Stress alone cannot put a healthy heart into A-fib (if it could everyone would be in AF!). However excessive caffeine use can sometimes trigger it and so can low potassium. The qestion is, why was your potasdium low? What regular medications are you on?

 

If your heart rate is now regular you may have been in what is called paroxysmal AF.

 

With just a borderline rise in Trop T  and no EKG sign of ischemia the only reason to have kept you would gave been if you were in severe heart failure which the doctor obviously did not think was the case. He opted for conservative approach and this seems to be working.

 

It may be  worth getting a thorough cardiac work up at some point  but does not sound urgent.  Assuming everything checks out OK on repeat visit, suggest you get full revords of the event and follow up while in UK. 

[PPMMUU]

I'd say that NT-proBNP is a very useful blood test to determine heart insufficiency. The price is out of my knowledge since I work in a government hospital, and patients don't have to pay.

 

If AFIB still persists, you will need regular checkups with a cardiologist or internal medicine doctor, or at least a doctor for months if not years. So, the choice of drug can be discussed with the doctor. I strongly advise against buying drugs over the counter, even if they are available over the counter in Thailand.

 

It seems you are leaving for the UK. I would suggest that you obtain a summary of your medical history from the doctor who performed the workup or another doctor at the same hospital. That would be very useful for further cardiac workup in the UK.

[sapson]

5 hours ago, Sheryl said:

Stress alone cannot put a healthy heart into A-fib (if it could everyone would be in AF!). However excessive caffeine use can sometimes trigger it and so can low potassium. The qestion is, why was your potasdium low? What regular medications are you on?

 

If your heart rate is now regular you may have been in what is called paroxysmal AF.

Yes for sure paroxysmal AF, had it for years for very short periods normally minutes at a time and irregular pulse and rapid heart rate can be reduced by Valsalva technique cold cloth etc, however Mondays 3am to 8am was a 5hr episode that I could not stop whatever i did and consequently fIrst tIme picked up on ECG as AF abnormal at the hospital that morning and trop t 15.5 very worrying.

 

 

Just back from hospital follow up now, had AF and pulse 105 bpm arriving getting off bike seems doing anything lively sets it off.

 

However calmed myself mind over heart and had the ECG, pulse still tad high 95bpm but it was a normal ECG .... what a relief and calmed down, the Tropnin t now reduced to 12.9 again good to see!1

 

Low Potassium 3,1  Monday was treated with only one dose 15ml elixir i knew it wasnt enough but had lost the will to fight with a totally rushed doctor and sure enough i requested a repeat test today again 3.1 .....so now have a five dose 15ml elixir course which i firmly insisted on. 

 

But indeed why is my Potassium consistently low ?? since 2017 when my body flesh muscle tone dramatically reduced..and huge weight loss..........doc today not interested daft really, isnt it a warning flag for a problem that needs addressing but which specialist do you turn to.

Checked prior 2014 to 2016 lab checks potassium levels always normal.

 

Regular meds daily 5mg amlodipine, omeprazole 20 mg, neurobion vit b complex x 2, 

vit c 1000mg and omega 3 fish oil 1000mg. and last 6 months 2 X 500 mg metformin.

 

sorry that was another book....

 

 

 

[Sheryl]

None of these meds would cause low potassium.

 

Heavy sweating could. So could diarrhea.

 

 

[sapson]

4 hours ago, PPMMUU said:

I'd say that NT-proBNP is a very useful blood test to determine heart insufficiency. The price is out of my knowledge since I work in a government hospital, and patients don't have to pay.

 

If AFIB still persists, you will need regular checkups with a cardiologist or internal medicine doctor, or at least a doctor for months if not years. So, the choice of drug can be discussed with the doctor. I strongly advise against buying drugs over the counter, even if they are available over the counter in Thailand.

 

It seems you are leaving for the UK. I would suggest that you obtain a summary of your medical history from the doctor who performed the workup or another doctor at the same hospital. That would be very useful for further cardiac workup in the UK.

Thanks for your response did indeed have the NT pro bnp today it was rather expensive 1300 baht maybe bought some peace of mind,,,not sure, the result was 150 pg/ml with their normal being 0-125 pg/ml so high by their lab parameters but doc said totally normal.

 

Doctor Google says anything over 125 pg/ml huge increase in cardiac event risk........whos telling it as it is? a young Thai cardiologist or professor google???

 

Seeing a UK doc older and with more grey hair than me and with a wealth of experience is one good thing about the UK and no language barrier although near impossible to see a doc unless near death,,,,,

 

Do you work in a government hospital here or the Uk or elsewhere?

[sapson]

16 minutes ago, Sheryl said:

None of these meds would cause low potassium.

 

Heavy sweating could. So could diarrhea.

 

 

lol.... have both of above but the latter has been major problem last 6 years did briefly consult GI doc who strongly suggested bowel colon cancer or if lucky only diverticulitis, advised first CT colonoscopy then another full colonoscopy if need for a biopsy,..... at a private hospital for two  procedures the price was crazy high,,,,,,, This is one for the UK health service think I trust them more with my backside than here and health issues major part of the reason for my return to UK.

Edited June 14, 2023 by sapson

[PPMMUU]

1 hour ago, sapson said:

Thanks for your response did indeed have the NT pro bnp today it was rather expensive 1300 baht maybe bought some peace of mind,,,not sure, the result was 150 pg/ml with their normal being 0-125 pg/ml so high by their lab parameters but doc said totally normal.

 

Doctor Google says anything over 125 pg/ml huge increase in cardiac event risk........whos telling it as it is? a young Thai cardiologist or professor google???

 

Seeing a UK doc older and with more grey hair than me and with a wealth of experience is one good thing about the UK and no language barrier although near impossible to see a doc unless near death,,,,,

 

Do you work in a government hospital here or the Uk or elsewhere?

The doctor's statement about the "normal" level of NT-proBNP likely refers to its role as a marker for determining the presence of chronic AF or chronic heart failure. If I remember correctly, the cutoff for distinguishing between these conditions is much higher than just above the normal range, possibly around 300-500.

 

Regarding determining normal or abnormal levels for specific conditions in specific patient groups, several international committees review the evidence and develop guidelines distributed to doctors. This process is carried out for virtually every disease.

There is a saying that is difficult to argue against, which states that the best doctor is the one you get to see.

 

I work in a government hospital in Thailand.

Wish you good health!

[sapson]

10 minutes ago, PPMMUU said:

I work in a government hospital in Thailand.

Wish you good health!

Thankyou!

You are a westerner i presume or Thai with excellent English skills, out of interest whats your position in the government hospital?

[PPMMUU]

35 minutes ago, sapson said:

Thankyou!

You are a westerner i presume or Thai with excellent English skills, out of interest whats your position in the government hospital?

I'm a Thai doctor with a somewhat passable English skills, with a little help from ChatGPT for grammar corrections.

[sapson]

1 minute ago, PPMMUU said:

I'm a Thai doctor with a somewhat passable English skills, with a little help from ChatGPT for grammar corrections.

Ok I understand now thanks!