رجل عمره ٧٢ سنة مدخن، عنده انسداد رئوي مزمن، جاء بضيق نفس متزايد منذ أسبوع وتورم بسيط في الكاحلين. الأشعة غير واضحة، والطبيب يريد التمييز بين فشل القلب وتفاقم أمراض الرئة. أي تحليل يساعد أكثر؟

A 72-year-old smoker with COPD has had increasing breathlessness for a week and mild ankle swelling. The X-ray is inconclusive, and the doctor wants to distinguish heart failure from a lung exacerbation. Which test helps most?

1. CK-MB and troponin
2. D-dimer
3. ALT and AST
4. BNP or NT-proBNP

Answer: D) BNP or NT-proBNP. Natriuretic peptide is released from stretched ventricles; a high level supports heart failure as the cause of dyspnoea and a low level makes it unlikely. It is affected by age and kidney function.