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Heart Failure

Heart Failure Diagnosis

A diagnosis of heart failure is based on a person's risk factor assessment, physical examination, laboratory tests, and other medical tests. In life-threatening situations, emergency treatment is started before the diagnosis is finalized.

Risk factor assessment

A heart failure risk factor assessment is based on person's medical history and the medical history of their family members. A doctor or other healthcare provider gathers information by asking specific questions. A questionnaire is often used to help organize the information.

  • The medical history contains information about a person's:
    • Health (high blood pressure, diabetes, previously diagnosed heart disease condition, thyroid condition)
    • Lifestyle (physical activity, smoking, alcohol use)
    • Drug use (prescription and over-the-counter medications, supplements, herbs, illegal drugs)
  • The family medical history contains information about health problems of family members.

Physical examination

The physical examination helps identify any heart disease symptoms. In addition to measuring a person's blood pressure and pulse, the doctor:

  • Listens to the chest for abnormal heart and lung sounds.
  • Examines the person's eyes, arms and legs, and skin.

Laboratory tests

Laboratory tests are ordered based on a person's risk factor assessment and physical examination. The tests checks for test results that fall outside of the normal ranges. Laboratory tests for heart failure may include:

  • Blood chemistry test (includes serum sodium, potassium, chloride, carbon dioxide, and blood urea nitrogen)
  • BNP (brain natriuretic peptide, which is a cardiac biomarker)
  • Cardiac enzymes (checks creatine kinase, myoglobin, and troponin)
  • Complete blood count
  • C-reactive protein test (blood protein that is a sign of inflammation)
  • Fasting glucose test (checks blood sugar level)
  • Lipoprotein profile (checks cholesterol and triglyceride levels)
  • Liver function test
  • Urinalysis

Medical tests

Additional medical tests help:

  • Identify the presence of a person's heart failure risk factors.
  • Rule out other diseases.
  • Identify the presence and severity of heart failure.
  • Determine a person's treatment options.

A person's risk factor assessment and physical exam determine which medical tests the doctor will order. Tests for heart failure may include:

  • Chest CT scan
    A chest CT scan (computed tomography scan) uses X-rays to produce cross-sectional computerized images of the heart and lungs. The CT scan identifies an enlarged heart, fluid in the lungs, and lung disease.
  • Chest X-ray
    A chest X-ray uses electromagnetic radiation to produce images of the heart, lungs, and blood vessels in the chest.
  • Coronary angiography with cardiac catheterization
    Coronary angiography uses X-rays to examine the coronary arteries after a radiopaque substance is injected into a coronary artery using cardiac catheterization. Cardiac catheterization passes a thin, flexible tube through a coronary artery or into the heart's chambers.
  • Echocardiogram
    An echocardiogram uses sound waves (ultrasound) to create moving images of the heart. The test identifies blood flow, heart contractions, and muscle damage.
  • Electrocardiogram (ECG, EKG)
    An ECG measures the heartbeat's rate and regularity.
  • Magnetic resonance imaging (MRI)
    MRI uses strong magnetic fields, radio waves, and a computer to create images of the structure of the heart without radiation or surgery.
  • Nuclear heart scan
    A radioactive tracer is injected into a person's bloodstream, and then pictures are taken of the heart's blood flow.
  • Stress test
    A stress test measures ECG and blood pressure while people exercise or after they take medication to make their hearts beat faster.