To highlight the importance of excluding other causes before attributing signs and symptoms and elevated brain natriuretic peptide levels to congestive heart failure (CHF), this article presents a case study of an elderly woman with a known history of CHF who presented to the emergency department with dyspnea.

Dyspnea is a sensation of the need to breathe or difficult or labored breathing. It leads to 2.5 million visits to healthcare providers annually in the United States.1 A number of abnormalities can cause dyspnea, and determining the etiology will allow institution of timely therapy and avoidance of unnecessary diagnostic tests.

Brain natriuretic peptide (BNP) is a neurohormone secreted by the left ventricle in response to pressure and volume overload. It produces natriuresis, a decrease in systemic vascular resistance, and a reduction in cardiac filling pressure. After publication of the results of the Breathing Not Properly Multinational Study,2 BNP levels...

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