Thousands of people are brought to hospital emergency departments in Singapore every year, distressed by shortness of breath. Many possible causes exist, such as anxiety, asthma, chest infections and respiratory diseases like chronic obstructive airways disease and most seriously, heart failure.
In the National University Hospital, about one quarter of breathless patients seen at the emergency department have heart failure. While the disease responds well to early treatment, diagnosis is challenging, frequently requiring more than asking questions about the patient’s symptoms, a stethoscope examination and chest x-ray. In fact, heart failure frequently masquerades as a developing chest infection in patients with long-standing chronic airways disease with bronchitis or emphysema, or as asthma with wheezing and cough.
Thus, reports over many years suggest emergency department doctors worldwide are seriously uncertain if heart failure is present in approximately half of the cases they handle.
However, that changed when it was discovered that hearts release small proteins called cardiac peptides into the bloodstream when the patients are under stress. Hence, by measuring the cardiac peptide levels in blood samples, doctors can now identify if heart failure is present and how serious the condition is.
Specifically, Professor Arthur Mark Richards, who is an honorary joint professor at NUS Medicine and director of the Cardiovascular Research Institute at the National University Heart Centre, Singapore discovered the diagnostic method of using the NT-proBNP heart peptide to perform blood tests for heart failure in 1995. This test has become so well proven that it is now mandated in all international guidelines on how to detect and treat heart failure.
Patients with damaged hearts tend to experience shortness of breath more quickly on exertion, such as climbing a few steps, before gradually finding themselves breathless when resting on their back at night or sitting up for relief. Finally, they may struggle for breath performing the simplest of activities or even when completely at rest, which reflects a build-up of fluid in their lungs due to heart failure.
When in doubt, consult a doctor to identify the cause of breathing problems for the appropriate treatment to be provided promptly, avoiding potentially serious consequences.