The first step your doctor will take to assess whether you have
congestive heart failure
(CHF) is to discuss your medical history and conduct a complete physical exam.
During the physical exam, your doctor will look for some of the characteristic signs of CHF, such as:
- Sound of fluid in the lungs
- Enlargement of the jugular vein in the neck
- Enlargement of the liver
- High blood pressure
or low blood pressure
Fast heart rate (
- Swelling of the ankles, legs, feet (edema)
Fluid in the abdominal cavity (
Fluid in the space between the lungs and ribs (
Afterwards the physical exam, your doctor may recommend tests to help make the diagnosis and assess the degree of damage. Examples of these tests include:
- Chest x-ray
—An x-ray image will show whether the heart is enlarged or whether congestion is present in the lungs.
Blood tests—The doctor will check for many conditions, such as
anemia, thyroid disorders, and
high cholesterol. In addition, your doctor will evaluate the functioning of your kidneys and liver and check the brain natriuretic peptide (BNP) level in your blood. The BNP level is used as an indicator for heart failure.
- Electrocardiogram (EKG or ECG)
—The EKG records the electrical activity of your heart through electrodes attached to the skin. This test will help diagnose heart rhythm problems, muscle abnormalities, and damage to the heart from a
—This test uses sound waves to produce an image of the working heart. This test helps evaluate the function of the heart's valves and chambers and determines the amount of blood ejected from the heart with each heartbeat. An echocardiogram also can detect structural damage, tumors, or excess fluid around the heart.
- Exercise stress test
—This test records the heart's electrical activity during increased physical activity. It may be coupled with an echocardiogram or myocardial perfusion imaging. Patients who cannot exercise may be given medicine intravenously (through a vein in the arm) that simulates the effects of physical exertion.
- Myocardial perfusion imaging
—During this test, radioactive material is injected into a vein and observed as it is absorbed by the heart muscle. Areas with diminished flow show up as dark spots on the scan.
- Coronary angiography
—Contrast dye is injected via a thin, flexible tube (catheter) that is threaded into the aorta or heart. X-rays are then taken to view blood flow and highlight the arterial blood vessels. This test helps to detect obstruction in the arteries and assess heart function.
Testing to check for blockage in the coronary arteries is recommended for some individuals with heart failure, especially younger patients and patients with symptoms of chest pain and
CT angiography and
electron-beam CT scan
—These tests are used to find blockages in the arteries. With CT angiography, a small amount of dye is injected into the blood vessels. As the dye passes through the heart, a very strong x-ray machine helps to show blood flow blockages. Electron-beam CT scan uses an electron "gun" instead of an x-ray machine to scan the chest.
—This test uses high intensity magnetic fields to generate high resolution images. It can help evaluate large blood vessels, coronary arteries, heart walls, and pericardium (double-walled sac that contains the heart).
Brain natriuretic peptide—a heart secretion. Brain Natriuretic Peptide website. Available at:
. Accessed August 7, 2012.
Heart failure. EBSCO DynaMed website. Available at:
. Updated August 3, 2012. Accessed August 7, 2012.
How is heart failure diagnosed? National Heart Lung and Blood Institute website. Available at:
. Updated January 9, 2012. Accessed August 7, 2012.
Last reviewed September 2012 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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