atrial natriuretic factor

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pertaining to an atrium.
atrial natriuretic factor (ANF) a hormone produced in the cardiac atrium; it inhibits renin secretion and thus the production of angiotensin, and stimulates aldosterone release. Its effect is increased excretion of water and sodium and a lowering of blood pressure, which reduces the workload of the heart.
atrial septal defect a congenital heart defect in which the ostium primum or ostium secundum, openings in the septum primum of the embryonic heart, fail to close completely after birth. When an opening remains between the atria, some of the oxygen-rich blood from the left atrium passes into the right atrium and travels back to the lungs without being first transported through the body.
 Atrial septal defect. The shunt is from left atrium to right atrium. From Betz et al., 1994.


an agent or element that contributes to the production of a result.
accelerator factor factor V, one of the coagulation factors.
factor I see coagulation factors.
factor II see coagulation factors.
factor III see coagulation factors.
factor IV see coagulation factors.
factor V see coagulation factors.
factor VI see coagulation factors.
factor VII see coagulation factors.
factor VIII see coagulation factors.
factor IX see coagulation factors.
factor X see coagulation factors.
factor XI see coagulation factors.
factor XII see coagulation factors.
factor XIII see coagulation factors.
angiogenesis factor a substance that causes the growth of new blood vessels, found in tissues with high metabolic requirements such as cancers and the retina. It is also released by hypoxic macrophages at the edges or outer surface of a wound and initiates revascularization in wound healing.
antihemophilic factor (AHF)
2. a preparation of factor VIII administered intravenously for the prevention or treatment of hemorrhage in patients with hemophilia A and the treatment of von Willebrand disease, hypofibrinogenemia, and coagulation factor XIII deficiency. Included are preparations derived from human plasma (antihemophilic factor, cryoprecipitated antihemophilic factor) or porcine plasma (antihemophilic factor [porcine]) and those produced by recombinant technology antihemophilic factor [recombinant]).
antihemophilic factor A factor VIII, one of the coagulation factors.
antihemophilic factor B factor IX, one of the coagulation factors.
antihemophilic factor C factor XI, one of the coagulation factors.
antihemorrhagic factor vitamin K.
antinuclear factor (ANF) antinuclear antibody.
antirachitic factor vitamin D.
atrial natriuretic factor (ANF) a hormone produced in the cardiac atrium; an inhibitor of renin secretion and thus of the production of angiotensin, and a stimulator of aldosterone release. Its effect is increased excretion of water and sodium and a lowering of blood pressure.
factor B a complement component that participates in the alternative complement pathway.
blastogenic factor lymphocyte-transforming factor.
carative f's in the theory of human caring, a set of ten factors that offer a descriptive topology of interventions including (1) a humanistic-altruistic system of values; (2) faith-hope; (3) sensitivity to self and others; (4) a helping-trusting, human care relationship; (5) the expression of positive and negative feelings; (6) a creative problem-solving caring process; (7) transpersonal teaching and learning; (8) a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment; (9) human needs assistance; and (10) existential-phenomenological-spiritual forces.
Christmas factor factor IX, one of the coagulation factors.
citrovorum factor folinic acid.
clotting f's coagulation factors.
C3 nephritic factor (C3 NeF) an autoantibody that stabilizes the alternative complement pathway C3 convertase, preventing its inactivation by factor h, resulting in complete consumption of plasma C3; it is found in the serum of many patients with type II membranoproliferative glomerulonephritis.
coagulation f's see coagulation factors.
colony-stimulating factor (CSF) any of a number of glycoproteins responsible for the proliferation, differentiation, and functional activation of hematopoietic progenitor cells; specific factors are named for the cell lines that they stimulate. Used to promote bone marrow proliferation in aplastic anemia, following cytotoxic chemotherapy, or following bone marrow transplantation. Types include granulocyte, granulocyte-macrophage, and macrophage colony-stimulating factors.
factor D a factor that when activated serves as a serine esterase in the alternative complement pathway.
decay accelerating factor (DAF) a protein of most blood as well as endothelial and epithelial cells, CD55 (see CD antigen); it protects the cell membranes from attack by autologous complement.
endothelial-derived relaxant factor (endothelial-derived relaxing factor) (endothelium-derived relaxing factor (EDRF)) nitric oxide.
extrinsic factor cyanocobalamin.
F factor (fertility factor) F plasmid.
fibrin-stabilizing factor (FSF) factor XIII, one of the coagulation factors.
Fletcher factor prekallikrein.
granulocyte colony-stimulating factor (G-CSF) a colony-stimulating factor that stimulates production of neutrophils from precursor cells.
granulocyte-macrophage colony-stimulating factor (GM-CSF) a colony-stimulating factor that binds to stem cells and most myelocytes and stimulates their differentiation into granulocytes and macrophages.
growth factor any substance that promotes skeletal or somatic growth; usually a mineral, hormone, or vitamin.
factor H a complement system regulatory protein that inhibits the alternative pathway of complement activation.
Hageman factor (HF) factor XII, one of the coagulation factors. See illustration.
Activation of Hageman factor (factor XII) leads to increased vascular permeability, clotting, and thrombolysis. From Damjanov, 2000.
hematopoietic growth f's a group of substances with the ability to support hematopoietic colony formation in vitro, including erythropoietin, interleukin-3, and colony-stimulating factors. All except erythropoietin stimulate mature cells, have overlapping capabilities to affect progenitor cells of several blood cell lines, and also affect cells outside the hematopoietic system.
histamine-releasing factor (HRF) a lymphokine, believed to be produced by macrophages and B lymphocytes, that induces the release of histamine by IgE-bound basophils. It occurs in late phase allergic reaction, six or more hours after contact with the antigen, in sensitive individuals.
homologous restriction factor (HRF) a regulatory protein that binds to the membrane attack complex in autologous cells, inhibiting the final stages of complement activation.
factor I a plasma enzyme that regulates both classical and alternative pathways of complement activation by inactivating their C3 convertases.
immunoglobulin-binding factor (IBF) a lymphokine having the ability to bind IgG complexed with antigen and prevent complement activation.
insulinlike growth f's (IGF) insulinlike substances in serum that do not react with insulin antibodies; they are growth hormone–dependent and possess all the growth-promoting properties of the somatomedins.
intensification factor in radiology, the comparative increase in light transmission when films are exposed in the presence of intensifying screens compared to that in the absence of screens.
intrinsic factor a glycoprotein secreted by the parietal cells of the gastric glands, necessary for the absorption of cyanocobalamin (vitamin B12). Its absence results in pernicious anemia.
LE factor an immunoglobulin that reacts with leukocyte nuclei, found in the serum in systemic lupus erythematosus.
lymph node permeability factor (LNPF) a substance from normal lymph nodes that produces vascular permeability.
lymphocyte mitogenic factor (LMF) (lymphocyte-transforming factor) a substance that is released by lymphocytes stimulated by specific antigen and causes nonstimulated lymphocytes to undergo blast transformation and cell division; called also blastogenic factor.
macrophage-activating factor (MAF) interferon-α.
macrophage colony-stimulating factor (M-CSF) a colony-stimulating factor secreted by macrophages, stimulated endothelial cells, and most tissues, that stimulates the production of macrophages from precursor cells and maintains the viability of mature macrophages in vitro.
macrophage chemotactic factor (MCF) a lymphokine that attracts macrophages to the invasion site.
macrophage-derived growth factor a substance released by macrophages below the surface of a wound that induces the proliferation of fibroblasts.
macrophage inhibition factor (macrophage inhibitory factor) migration inhibitory factor.
migration inhibition factor (migration inhibitory factor) a lymphokine that inhibits macrophage migration.
minification factor in radiology, the gain in light achieved by a reduction in size of the output phosphor from the input phosphor size.
osteoclast-activating factor (OAF) a lymphokine that stimulates bone resorption; it may be involved in the bone resorption associated with multiple myeloma and other hematologic neoplasms or inflammatory disorders such as rheumatoid arthritis and periodontal disease.
factor P properdin.
platelet f's see platelet factors.
platelet-activating factor (PAF) a substance released by basophils and mast cells in immediate hypersensitivity reactions, and by macrophages and neutrophils in other inflammatory reactions; it leads to bronchoconstriction, platelet aggregation, and release of vasoactive substances from platelets.
platelet-derived growth factor a substance contained in platelets and capable of inducing proliferation of vascular endothelial cells, vascular smooth muscle cells, fibroblasts, and glial cells; its action contributes to the repair of damaged vascular walls.
R factor R plasmid.
releasing f's factors elaborated in one structure (as in the hypothalamus) that effect the release of hormones from another structure (as from the anterior pituitary gland), including corticotropin-releasing factor, melanocyte-stimulating hormone–releasing factor, and prolactin-releasing factor. Applied to substances of unknown chemical structure, while substances of established chemical identity are called releasing hormones.
resistance factor R f.
Rh factor a type of agglutinogen found on some erythrocytes; see also rh factor.
rheumatoid factor (RF) antibodies directed against antigenic determinants on IgG molecules, found in the serum of about 80 per cent of patients with classic or definite rheumatoid arthritis; but in only about 20 per cent of patients with juvenile rheumatoid arthritis; rheumatoid factors may be IgM, IgG, or IgA antibodies, although serologic tests measure only IgM. Rheumatoid factors also occur in other connective tissue diseases and infectious diseases.
risk factor an agent or situation that is known to make an individual or population more susceptible to the development of a specific negative condition.
risk factor (omaha) an environmental, psychosocial, or physiologic event or health related behavior that increases the client's exposure or vulnerability to the development of a client problem; the nurse's knowledge base of risk factors is used to identify potential problem modifiers in the Problem Classification scheme of the omaha system.
stable factor factor VII, one of the coagulation factors.
Stuart factor (Stuart-Prower factor) factor X, one of the coagulation factors.
sun protection factor (SPF) a numerical rating of the amount of protection afforded by a sunscreen; the higher the number, the more protection is provided.
tissue factor factor III, one of the coagulation factors.
transfer factor (TF) a factor occurring in sensitized lymphocytes that can transfer delayed hypersensitivity to a formerly nonreactive individual; see also transfer factor.
tumor necrosis factor (TNF) either of two lymphokines produced primarily by cells of the immune system, capable of causing in vivo hemorrhagic necrosis of certain tumor cells but not normal cells. They also destroy cells associated with the inflammatory response. They have been used as experimental anticancer agents but can also induce shock when bacterial endotoxins cause their release. Tumor necrosis factor α, formerly called cachectin, contains 157 amino acids and is produced by macrophages, eosinophils, and NK cells. Tumor necrosis factor β is lymphotoxin and contains 171 amino acids.
vascular endothelial growth factor (VEGF) (vascular permeability factor (VPF)) a peptide factor that stimulates the proliferation of cells of the endothelium of blood vessels; it promotes tissue vascularization and is important in blood vessel formation in tumors.
von Willebrand's factor (vWF) a glycoprotein synthesized in endothelial cells and megakaryocytes that circulates complexed to coagulation factor VIII. It is involved in adhesion of platelets to damaged epithelial surfaces and may participate in platelet aggregation. Deficiency results in the prolonged bleeding time seen in von Willebrand's disease.

a·tri·al na·tri·u·ret·ic fac·tor (ANF),

an early name given to a natriuretic factor derived from cardiac atria. Because the factor is now known to be a peptide, however, the term is no longer used.

a·tri·al na·tri·u·ret·ic fac·tor

(ANF) (ātrē-ăl nātrē-yūr-etik faktŏr)
A hormone produced by cardiac atria in response to increased fluid volume or pressure.

Atrial Natriuretic Peptide

Synonym/acronym: Atrial natriuretic hormone, atrial natriuretic factor, ANF, ANH, APN.

Common use

To assist in diagnosing and monitoring congestive heart failure (CHF) and to differentiate CHF from other causes of dyspnea.


Plasma (1 mL) collected in a chilled, lavender-top tube. Specimen should be transported tightly capped and in an ice slurry.

Normal findings

(Method: Radioimmunoassay)
Conventional UnitsSI Units (Conventional Units × 1)
20–77 pg/mL20–77 ng/L


Atrial natriuretic peptide or atrial natriuretic factor (ANF) is a hormone secreted from cells in the right atrium of the heart when right atrial pressure increases. The release of this cardiac peptide is stimulated by increases in the stretch of the atrial wall caused by an increase in blood pressure or blood volume. ANF receptors are also stimulated by elevated sodium levels. This extremely potent hormone enhances salt and water excretions by blocking aldosterone and renin secretion. ANF inhibits angiotensin II and vasopressin, resulting in vasodilation and a decrease in blood volume and blood pressure.

This procedure is contraindicated for



  • Assist in the confirmation of congestive heart failure (CHF), as indicated by increased level
  • Identify asymptomatic cardiac volume overload, as indicated by increased level

Potential diagnosis

Increased in

  • ANP is secreted in response to increased hemodynamic load caused by physiological stimuli as with atrial stretch or endocrine stimuli from the aldosterone/renin system.

  • Asymptomatic cardiac volume overload
  • CHF
  • Elevated cardiac filling pressure
  • Paroxysmal atrial tachycardia

Decreased in


Critical findings


Interfering factors

  • Drugs that may increase ANF levels include atenolol, candoxatril, captopril, carteolol, morphine, oral contraceptives, vasopressin, and verapamil.
  • Drugs that may decrease ANF levels include clonidine, erythropoietin, prazosin, ramipril, and urapidil.
  • Recent radioactive scans or radiation within 1 wk before the test can interfere with test results when radioimmunoassay is the test method.
  • Failure to follow dietary and medication restrictions before the procedure may cause the procedure to be canceled or repeated.

Nursing Implications and Procedure


  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching:  Inform the patient this test can assist in assessing heart function.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex. Be alert to signs and symptoms of altered cardiopulmonary tissue perfusion related to ventilation-perfusion imbalance, decreased cardiac output related to altered muscle contractility, and fluid-volume excess related to glomerular filtration rate.
  • Obtain a history of the patient’s cardiovascular system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and neutraceuticals (see Effects of Natural Products on Laboratory Values).
  • Note any recent procedures that may interfere with test results.
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues,  as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to fast for 6 to 12 hr before the test and to avoid taking medications that interfere with test results, as directed by the health-care provider (HCP). Note: Drugs such as β-blocking agents, calcium antagonists, cardiac glycosides, and vasodilators can affect results.
  • Prepare an ice slurry in a cup or plastic bag to have ready for immediate transport of the specimen to the laboratory. Prechill the specimen collection tube in the ice slurry.


  • Potential complications: N/A
  • Ensure that the patient has complied with dietary, medication, or activity restrictions and pretesting preparations; assure that food has been restricted for at least 6 to 12 hr prior to the procedure.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • The sample should be placed in an ice slurry immediately after collection. Information on the specimen label should be protected from water in the ice slurry by first placing the specimen in a protective plastic bag. Promptly transport the specimen to the laboratory for processing and analysis.


  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Instruct the patient to resume usual diet and medication, as directed by the HCP.
  • Nutritional Considerations: Increased ANF may be associated with coronary artery disease (CAD). Nutritional therapy is recommended for patients identified to be at risk for developing CAD or for individuals who have specific risk factors and/or existing medical conditions (e.g., elevated LDL cholesterol levels, other lipid disorders, insulin-dependent diabetes, insulin resistance, or metabolic syndrome). Other changeable risk factors warranting patient education include strategies to encourage patients, especially those who are overweight and with high blood pressure, to safely decrease sodium intake, achieve a normal weight, ensure regular participation in moderate aerobic physical activity three to four times per week, eliminate tobacco use, and adhere to a heart-healthy diet. If triglycerides also are elevated, the patient should be advised to eliminate or reduce alcohol. The 2013 Guideline on Lifestyle Management to Reduce Cardiovascular Risk published by the ACC and AHA in conjunction with the NHLBI recommends a “Mediterranean”-style diet rather than a low-fat diet. The new guideline emphasizes inclusion of vegetables, whole grains, fruits, low-fat dairy, nuts, legumes, and nontropical vegetable oils (e.g., olive, canola, peanut, sunflower, flaxseed) along with fish and lean poultry. A similar dietary pattern known as the DASH diet makes additional recommendations for the reduction of dietary sodium. Both dietary styles emphasize a reduction in consumption of red meats, which are high in saturated fats and cholesterol, and other foods containing sugar, saturated fats, trans fats, and sodium.
  • Recognize anxiety related to test results, and be supportive of fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Provide contact information, if desired, for the American Heart Association ( or the National Heart, Lung, and Blood Institute (
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include aldosterone, antiarrhythmic drugs, ADH, apolipoprotein A and B, AST, BNP, blood gases, CRP, calcium/ionized calcium, cholesterol (total, HDL, and LDL), CK and isoenzymes, CT scoring, echocardiography, glucose, glycated hemoglobin, Holter monitor, homocysteine, ketones, LDH and isoenzymes, lipoprotein electrophoresis, magnesium, MRI chest, myocardial infarct scan, myocardial perfusion heart scan, myoglobin, PET heart, potassium, renin, sodium, triglycerides, and troponin.
  • See the Cardiovascular System table at the back of the book for related tests by body system.
References in periodicals archive ?
Renal expression of the gene for atrial natriuretic factor.
Solid-phase double-antibody radioimmunoassay for atrial natriuretic factor.
Direct radioimmunoassay of atrial natriuretic factor.

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