Heart failure - tests
CHF - tests; Congestive heart failure - tests; Cardiomyopathy - tests; HF - tests
The diagnosis of heart failure is made largely on a person's symptoms and a physical exam. However, there are many tests that can help give more information about the condition.
If you cough a lot, often feel weak, have lost your appetite, and need to urinate a lot at night, you might have symptoms of heart failure. Heart failure is a long-term condition that usually comes on slowly. However, it can develop suddenly, for instance, after a heart attack. You have heart failure when your heart does not pump blood out of your heart very well, or when your heart muscles are stiff and do not easily fill up with blood. When you have heart failure, your heart cannot pump enough oxygen-rich blood to the rest of your body, especially when you exercise or move around a lot. As the heart loses the ability to pump blood, blood backs up in other parts of your body, including your lungs, liver, gastrointestinal tract, and your arms and legs. The most common cause of heart failure is coronary artery disease, the narrowing of the blood vessels that supply blood and oxygen to your heart. So, how do you know if you have heart failure? Get to your doctor. You may have trouble breathing, an irregular heartbeat, swollen legs, neck veins that stick out, and sounds from fluid built up in your lungs. Your doctor will check for these and other signs of heart failure. A test called an echocardiogram is often the best test to diagnose your heart failure. Your doctor can also use this test to find out why you have heart failure, and then monitor your condition going forward every three to six months. Your doctor will talk to you about knowing your body and symptoms that mean your heart failure is getting worse. You will need to learn to watch for changes in your heart rate, pulse, blood pressure, and weight. You will also need to limit salt in your diet, stop drinking alcohol, quit smoking if you need to, exercise, lose weight if you need to, and get enough rest. Your doctor will probably ask you to take medicines to treat your heart failure. These medicines can treat your symptoms, prevent your heart failure from getting worse, and help you live longer. If you have heart failure, taking your medicines, changing your lifestyle, and treating the condition that caused heart failure can go a long way toward improving your health. But heart failure is a chronic, or long-term, illness, which means it may get worse over time. Make sure you call your doctor if you start coughing more, have sudden weight gain or swelling, or feel week. Have someone take you to the emergency room right away if you have trouble with fainting, a fast and irregular heartbeat, or feel severe crushing chest pain.
An echocardiogram (echo) is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image.
This test helps your health care provider learn more about how well your heart contracts and relaxes. It also provides information about the size of your heart and how well the heart valves are working.
An echocardiogram is the best test to:
- Identify which type of heart failure (systolic, diastolic, valvular)
- Monitor your heart failure and guide your treatment
Heart failure can be diagnosed if the echocardiogram shows that the pumping function of the heart is too low. This is called an ejection fraction. A normal ejection fraction is around 55% to 65%.
If only some parts of the heart are not working correctly, it may mean that there is a blockage in the artery of the heart that delivers blood to that area.
Other Imaging Tests
Many other imaging tests are used to look at how well your heart is able to pump blood and the extent of heart muscle damage.
You may have a chest x-ray done in your provider's office if your symptoms suddenly become worse. However, a chest x-ray cannot diagnose heart failure.
Ventriculography is another test that measures the overall squeezing strength of the heart (ejection fraction). Like an echocardiogram, it can show parts of the heart muscle that are not moving well. This test uses x-ray contrast fluid to fill the pumping chamber of the heart and evaluate its function. It is often done at the same time as other tests, such as coronary angiography.
MRI, CT, or PET scans of the heart may be done to check how much heart muscle damage is present. It can also help detect the reason for a patient's heart failure.
Stress tests are done to see whether the heart muscle is getting enough blood flow and oxygen when it is working hard (under stress). Types of stress tests include:
Your provider may order a heart catheterization if any imaging tests show that you have narrowing in one of your arteries, or if you are having chest pain (angina) or a more definitive test is desired.
Several different blood tests can be used to learn more about your condition. Tests are done to:
- Help diagnose the cause for and monitor heart failure.
- Identify risk factors for heart disease.
- Look for possible causes of heart failure or problems that may make your heart failure worse.
- Monitor side effects of medicines you may be taking.
Blood urea nitrogen (BUN) and serum creatinine tests help monitor how well your kidneys are working. You will need these tests regularly if:
- You are taking medicines called ACE inhibitors or ARBs (angiotensin receptor blockers)
- Your provider makes changes to the doses of your medicines
- You have more severe heart failure
Sodium and potassium levels in your blood will need to be measured on a regular basis when there are changes made for some medicines including:
- ACE inhibitors, ARBs, or certain types of water pills (amiloride, spironolactone, and triamterene) and other medicines that can make your potassium levels too high
- Most other types of water pills, which can make your sodium too low or your potassium too high
Anemia, or low red blood cell count, can make your heart failure worse. Your provider will check your CBC or complete blood count on a regular basis or when your symptoms become worse.
Greenberg B, Kim PJ, Kahn AM. Clinical evaluation of heart failure. In: Felker GM, Mann DL, eds. Heart Failure: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, PA: Elsevier, 2020:chap 31.
Mann DL. Management of patients with heart failure with reduced ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 25.
Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Cardiac Failure. 2017;23(8):628-651. PMID: 28461259
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240-e327. PMID: 23741058
Last reviewed on: 5/8/2021
Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.