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Answer 2
  1. B-type natriuretic peptide. The patient has numerous specific findings indicating that he is in heart failure. This case does not require any laboratory test to confirm the diagnosis, but the diagnosis is not so clear in many cases. Previously, this patient was mistakenly treated for pneumonia. The recent development of an inexpensive and sensitive assay for BNP, a peptide released from ventricular myocardium in response to volume or pressure overload, has been useful in diagnosing patients with dyspnea in emergency rooms. Total bilirubin is often elevated from hepatic congestion in CHF, but this finding is nonspecific. C-reactive protein level is also a nonspecific finding and may be elevated in the absence of CHF. Troponin I, a cardiac-specific protein released from injured myocytes, can be elevated in CHF but also may rise in myocardial infarction, pulmonary embolus, and with other cardiac injuries; it is not a specific or sensitive marker for CHF.

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