If your doctor suspects you have heart failure based on your symptoms, he or she will discuss your personal and family medical history with you, perform a physical exam and order one or more tests. The diagnosis is made based on the findings from the medical histories, physical exam and any tests that were ordered. If you are under the care of a primary care physician, he or she will refer to you a cardiologist, a doctor with specialized training in diagnosing and treating heart problems.
Personal and Family Medical History
Your physician will review your personal medical history, as well as gather information about conditions that your family members have had. He or she will be looking for personal or familial risk factors such as coronary artery disease (disease in the arteries that supply the heart muscle with blood), heart attack, high blood pressure, and diabetes. Your doctor will want to know if anyone in your family has had heart failure.
For the physical exam, your doctor will examine your abdomen, legs, ankles, feet and the veins in your neck for signs of swelling and fluid retention. He or she will also use a stethoscope to listen for sounds of congestion in your lungs or sounds that could indicate problems with your heart. If, based on the medical histories and physical exam, your physician needs additional information to either diagnose or rule out heart failure, tests will be ordered.
A range of tests may be ordered by your doctor to determine the cause of your symptoms and to diagnose or rule out heart failure. All of these tests will not be necessary for every patient. Common tests include the following:
- Echocardiogram. This test is considered to be the most important one in terms of diagnosing heart failure. However, this test cannot provide enough information alone for a definitive heart failure diagnosis. An echocardiogram, sometimes called a Doppler, heart ultrasound or “echo,” is a noninvasive test that uses sound waves to create a moving picture of the heart. It can help your doctor see if the main pumping chamber of the heart (left ventricle) is functioning well, check for problems with the valves that regulate blood flow through the heart and look for evidence of a prior heart attack. It can also check whether the walls of the heart’s pumping chambers have thickened, which is a sign of strain on the heart.
- Electrocardiogram (ECG or EKG). An electrocardiogram records the electrical activity of the heart. The heart muscle has an electrical system that governs the rhythm of how the heart’s chambers expand and contract—this is your heartbeat. An electrocardiogram can identify heart rhythm problems, suggest possible heart chamber thickening or enlargement and also suggest possible damage from a prior heart attack.
- Chest x-ray. A chest x-ray produces an image of the inside of the chest showing the bones, heart and blood vessels. This test can show if your heart muscle is enlarged or if there is fluid build-up in the lungs.
- BNP (B-type naturetic peptide) blood test. This test can identify elevated levels of BNP hormone in your bloodstream. Elevated BNP hormone levels can be one indicator of heart failure.
- Cardiac catheterization/angiogram (left heart catheterization). This test is an invasive test where an interventional cardiologist threads a slender, flexible tube called a catheter into the arteries of your heart and injects x-ray dye. The dye allows the interventional cardiologist to see the flow of blood to the heart muscle and how well the heart is pumping.
- Thyroid function test. This blood test can measure your thyroid hormone levels. If these levels are too high or too low, it can lead to heart failure.
- Stress test. There are different types of stress tests, including exercise treadmill stress tests, echo stress tests and nuclear stress tests), but you will usually exercise by walking or running on a treadmill or pedaling a stationary bicycle. While your heart is working hard, one of several types of imaging tests (EKG, echo or nuclear) will be used to evaluate how much blood flow is getting to the heart and how effectively the heart is pumping. This test can identify problems that may be more visible when your heart muscle is working harder.
- Catheterization to measure pulmonary pressure (right heart catheterization). During this test, a catheter is advanced to the pulmonary artery (the artery that carries blood from the heart to the lungs to pick up oxygen). This test allows the physician 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. A Holter monitor is a device that records your heart’s rate and rhythm, usually over a period of 24 to 48 hours. The monitor is a small, box-shaped electronic device that is connected with wires (leads) to sticky patches (electrodes) that are placed on the skin of your chest. The monitor is attached to a strap that goes around your shoulder or waist to hold it close to your body.
- PET scan. This test uses a radioactive tracer to create images of organ functioning in the body. In the heart, it can show areas of decreased blood flow.
- Magnetic resonance imaging (MRI). MRI uses radio waves and magnets to produce images of the heart and blood vessels that are interpreted by a computer. This test can help identify heart failure or common causes of the condition, such as prior heart attack. (Note: An MRI is not typically used to look at the coronary arteries, the arteries that supply the heart muscle with blood.)
- Six-minute walk test. This test may be performed initially and then after treatment with a heart failure patient to provide an objective way to measure activity tolerance. It measures how far the patient can walk down a flat, 100-foot hallway in a six-minute time span.
If you are diagnosed with heart failure, treatment will consist of lifestyle changes and prescribed medications. Depending on your individual case and the severity of heart failure, other in-hospital treatments may be recommended as well. To learn more, visit Heart Failure Treatment.