Congestive Heart Failure: Diagnosis

Medical and family histories are very important in diagnosis congestive heart failure. If you or a family member has a condition that damages the heart, such as diabetes or coronary artery disease, you are at greater risk for developing congestive heart failure. Your doctor will also closely evaluate any symptoms you may have.

A physical exam is usually necessary. Your doctor will examine your heart and lungs carefully, checking for abnormal sounds and fluid buildup.

Several specific tests are used together to diagnose congestive heart failure:

• EKG Test: This measures how fast your heart is beating and looks for an irregular heart rhythm. It also determines if your heart walls are thicker than normal and whether or not you've previously had a heart attack.
• Chest X-ray: An X-ray can show heart enlargement, fluid in the lungs, and lung disease.
• BNP Blood Test: This measures the level BNP in the body, a hormone. Its levels increase during heart failure.
• Cardiac MRI: A cardiac MRI can often be used to help determine the causes of heart failure and can also accurately measure the heart's pumping function.
• Stress Test: Many times, determining if there is a heart blockage (coronary artery disease), can be useful in treating heart failure.

Additional Tests

Your doctor may recommend a cardiologist after these initial tests in order to confirm a diagnosis of heart failure. Follow-up tests with the cardiologist may include:

• Echocardiography: This test uses sound waves to produce an image of the heart, showing how well it's working. It can help determine which areas of the heart are having problems and help identify any damage to the heart.
• Doppler Imaging: This test uses sound waves to measure the speed and direction of blood flow and valvular function.
• Holter Monitor: A Holter monitor is a small box that you carry in a pouch around your neck or clipped to your belt. The monitor is attached to electrodes that are placed on your chest which records the rhythm of your heart while you go about your day normally.
• Nuclear Heart Scan: (This is usually part of a stress test.) This determines how well blood is moving through your heart and how much blood is reaching your heart muscle.
• Cardiac Catheterization (Angiography): A thin, flexible tube called a catheter is put into a blood vessel in your arm, upper thigh, or neck and threaded to your heart to study the interior of coronary arteries and measure heart function. A dye that can be seen with X-rays is injected into the blood through the tip of the catheter. The dye allows your doctor to see blood flow to the heart muscle.  
• Stress Test: In a stress test, you perform a physical activity, such as jogging on a treadmill, to increase the speed of your heartbeat. This helps determine how well your heart performs when it must work. 
• Cardiac Magnetic Resonance Imaging (MRI): An MRI shows the structure and beating of your heart. It can show signs of damage.
• Positron Emission Tomography (PET): A PET scan can help your doctor see whether enough blood is flowing to and from the heart.
• Thyroid Function Tests: Having too much or too little thyroid hormone in the blood can cause heart failure, so various thyroid tests are performed to determine if the cause of heart failure is due to thyroid problems.