Congestive Heart Failure

Diagnosis

Typically, physicians diagnose heart failure by taking a careful medical history and performing a physical examination. The physician also checks for the presence of risk factors such as high blood pressure. Using a stethoscope, a physician listens as a patient breathes and can identify the sounds of lung congestion. The stethoscope also picks up abnormal heart sounds that may indicate heart failure.

In addition to a physical exam, the doctor may recommend any of a variety of tests to diagnose congestive heart failure. The patient may be referred to a cardiologist — a doctor who specializes in the study of the heart and its function — for tests such as:

Chest X-ray

X-ray images help the doctor see the condition of the lungs and heart. In congestive heart failure, a heart may appear enlarged on an X-ray and fluid accumulation may be visible in the lungs. An X-ray can also be used to diagnose conditions other than congestive heart failure that may explain a patient's symptoms.

Electrocardiogram (ECG)

ECG tests record the electrical activity of the heart through electrodes attached to the skin. Impulses are recorded as waves displayed on a monitor or printed on paper. This test helps the doctor diagnose heart rhythm problems and damage to the heart from a heart attack that may be underlying congestive heart failure.

Echocardiogram

An echocardiogram uses sound waves to produce a video image of the heart. This image can help doctors determine the capacity at which the heart is pumping. The percentage of blood pumped out of the heart's main pumping chamber (the left ventricle) with each heartbeat is referred to as the ejection fraction. This percentage can be measured by an echocardiogram or other imaging techniques. In a healthy heart, the ejection fraction is greater than 50 percent. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure.

Coronary Catheterization (Angiogram)

In this test a thin, flexible tube (catheter) is inserted into a blood vessel at the groin or elbow and guided through the main artery, the aorta, into the coronary (heart) arteries. A dye injected through the catheter makes the arteries supplying the heart visible on an X-ray. This test helps doctors identify narrowed arteries to the heart (coronary artery disease) that can be a cause of congestive heart failure. The test also helps doctors determine the strength of the left ventricle — the heart's main pumping chamber — and the health of the heart valves.

Radionuclide Ventriculography or Multiple-gated Acquisition Scanning (MUGA)

This nuclear medicine test involves injecting a small amount of radioactive dye into a vein, then taking pictures of the heart as it pumps blood. Like an echocardiogram, this test shows how much blood the heart can pump with each beat.

Exercise Testing

Exercise testing is frequently used to measure a heart's functional capacity. The exercise testing will assist the doctor with judging the response to therapy and the timing of more advanced treatments.

Blood tests

The doctor may take a sample of blood to check for indicators of other diseases that affect the heart. In addition, he or she may order a new blood test for congestive heart failure. The test checks for levels of a hormone called B-type natriuretic peptide (BNP). The heart secretes BNP in high levels when it's overworked. A large amount of BNP in the blood may indicate congestive heart failure.

Results of these tests help doctors determine the cause of a patient's signs and symptoms and develop a treatment plan. To determine the best course of treatment, doctors classify heart failure using a scale of one to four. Class I heart failure is the mildest. A person can perform everyday activities and not feel winded or fatigued. Class IV is the most severe, in which a person is short of breath even at rest.