Approximately 6.2 million adults in the U.S. have heart failure.1 If you suspect you have heart failure based on your symptoms, your doctor will discuss your personal and family medical history with you, perform a physical exam, and order one or more tests to make or rule out a heart failure diagnosis. If you receive a heart failure diagnosis, your doctor may refer you to a cardiologist with specialized training in diagnosing and treating heart problems. Your cardiologist will classify the severity of your heart failure based on your medical history, physical exam, and test results and discuss a treatment plan for you.
Personal and family medical history
Your doctor will review your medical history and gather information about conditions your family members have had. Your doctor will look for personal or familial risk factors such as coronary artery disease (CAD), heart attack, hypertension (high blood pressure), and diabetes. Your doctor will also want to know if family members have had heart failure.
During your physical exam, your doctor will examine your abdomen, legs, ankles, feet, and the veins in your neck for signs of swelling and fluid retention. Your doctor will also use a stethoscope to listen for lung congestion or sounds that could indicate problems with your heart. If additional information is needed to diagnose or rule out heart failure, your doctor will order a series of tests.
Your doctor may order a range of tests to determine your symptoms' cause and diagnose or rule out heart failure. All of these tests will not be necessary for every patient, but common tests include the following:
- Echocardiogram (Doppler, heart ultrasound, or echo) – This test is considered the most important in diagnosing heart failure and is a noninvasive test that uses sound waves to create a moving picture of the heart. It helps determine a heart’s ejection fraction, the percentage of blood the heart’s ventricles push out of the heart. It’s important to note that even a healthy ventricle does not pump out 100% of the blood, and a normal heart may have an ejection fraction between 55%–70%.
- Electrocardiogram (ECG or EKG) – This test records the heart's electrical activity.
- Chest X-ray – A chest x-ray produces an image of the inside of the chest showing the bones, heart, and blood vessels and can show if your heart muscle is enlarged or fluid buildup in the lungs.
- BNP (B-type natriuretic peptide) blood test – This test can identify elevated levels of BNP hormone in your bloodstream, one indicator of heart failure.
- Cardiac catheterization/angiogram (left heart catheterization) – This test involves an X-ray dye being injected into your heart's arteries to see the blood flow to the heart muscle and how well the heart is pumping.
- Thyroid function test – This blood test can measure your thyroid hormone levels. Thyroid levels that are too high or too low can lead to heart failure.
- Stress test – This test can identify problems that may be more visible when your heart muscle is working harder and usually involves you walking or running on a treadmill or pedaling a stationary bicycle, followed by an imaging test to evaluate how much blood flow is getting to your heart and how effectively your heart is pumping.
- Catheterization to measure pulmonary pressure (right heart catheterization) – This test allows your doctor to measure pulmonary pressure. If this pressure is too high, it can indicate pulmonary hypertension, which is increased pressure in the arteries that carry blood from your heart to your lungs.
- Holter monitor – This small, box-shaped device records your heart’s rate and rhythm, usually throughout 24 to 48 hours, and can help identify heart failure.
- PET scan – This test uses a radioactive tracer to create images of the heart, showing areas of decreased blood flow.
- Magnetic resonance imaging (MRI) – This test uses radio waves and magnets to produce images of the heart and blood vessels to help identify heart failure or common causes of the condition, such as a prior heart attack.
- Six-minute walk test – This test may be performed initially and after treatment with a heart failure patient to objectively measure activity tolerance. It measures how far the patient can walk down a flat, 100-foot hallway in six minutes.
If you are diagnosed with heart failure, treatment will consist of lifestyle changes and prescribed medications. Certain procedures and surgeries may also be recommended depending on the severity of your heart failure.