Heart failure

How is heart failure diagnosed? Examination, tests, symptoms

Although the term “heart failure” suggests that the heart has stopped working, it actually means that the heart has become weaker or stiffer and is no longer pumping as efficiently as it used to be.

As a result, blood flow to all organs and tissues in your body is less efficient if you have heart failure. This can lead to potentially serious complications and symptoms.

In addition to a physical exam and examining your symptoms, your doctor may use several tests to help diagnose heart failure. Read on to find out more.

One of the first things a healthcare professional will do is examine your symptoms and perform a physical exam.

As part of your physical examination, they:

  • gain your weight while standing on a scale
  • check for swelling in the lower limbs or abdomen
  • check for an enlarged kidney
  • listen to your heart and lungs with a stethoscope to check for sounds that may indicate fluid buildup in your chest
  • listen to your heartbeat and other sounds to help them determine if your heart is working as expected

Your doctor may also perform a jugular venous pressure (JVP) exam as part of a physical exam. During a JVP exam, they can measure the bulge in your jugular vein to help determine if there is pressure in your vena cava. The vena cava is a large vein that carries blood to your heart.

A common early symptom of heart failure is feeling tired more quickly than usual after light exertion. As your heart muscles weaken and the disease progresses, symptoms may also include:

  • shortness of breath
  • cough, especially when lying down
  • tired
  • weakness
  • difficulty concentrating
  • swelling of the lower limbs or abdomen due to fluid retention
  • weight gain

Be sure to review all of your symptoms with the doctor, even if you are not sure whether they are relevant. Examining your symptoms, along with several tests of your heart function, will help the doctor make an accurate diagnosis.

Your doctor may use one or more of the following tests to help diagnose heart failure:

  • Blood tests will help a doctor check for biomarkers – such as type B natriuretic peptide (BNP) or pro-BNP – that increase during heart failure.
  • An echocardiogram, or echo, is a non-invasive test that uses sound waves to measure your heart’s ejection fraction. It is the percentage of blood in the left ventricle that is pumped to the body. This is an important sign of your heart’s ability to pump blood.
  • Heart CT scans and MRI scans can reveal the heart’s anatomy and function.
  • Heart catheterization can tell a doctor if your blood vessels are blocked. For this test, a healthcare professional will place a catheter into a blood vessel and then guide it to your heart.
  • An electrocardiogram, sometimes called an ECG or ECG, involves electrodes placed on your chest and connected to a computer to record your heart rate.
  • A Holter monitor is a portable ECG that can be worn for hours or days at a time.
  • A stress test helps a doctor assess how well your heart is working during physical activity. This is usually done on a treadmill or stationary bike.
  • A chest x-ray can look for an enlarged heart and fluid in or around your lungs.

The American Heart Association notes that you may have some or all of these tests depending on your symptoms and what the initial tests reveal.

The clinical criteria for diagnosing heart failure fall into two categories: major and minor. Both major and minor criteria symptoms must be present for a healthcare professional to make a diagnosis.

Major criteria

  • sudden buildup of fluid in the lungs, known as acute pulmonary edema
  • cardiomegaly or enlarged heart
  • swelling of the jugular vein, known as jugular vein distension
  • hepatojugular reflux, which causes the vein in the neck to stretch when pressure is applied to the liver
  • feeling short of breath when lying down or asleep, known as paroxysmal nocturnal dyspnea
  • lung rattles, or a clicking or bubbling sound in the lungs
  • third heart sound, which is identified by a brief heart vibration when the heart relaxes between beats
  • weight loss greater than 10 pounds (4.5 kilograms) in 5 days in response to treatment

Minor criteria

  • swelling of the lower legs due to fluid retention, known as ankle edema
  • feeling short of breath during physical activity, clinically known as exertional dyspnea
  • enlarged liver or hepatomegaly
  • cough at night, usually when lying down, known as a nocturnal cough
  • buildup of fluid around the lungs, also called pleural effusion
  • tachycardia or resting heart rate greater than 120 beats per minute

Once heart failure is diagnosed, your doctor will also determine a particular class and stage. This is based on the severity of your symptoms and the presence of cardiovascular disease, as well as the extent to which your condition limits your physical activity.

The classification will then guide your treatment options. If you have acute heart failure, you will stay in the hospital, possibly on oxygen, until your health stabilizes.

Even if your heart failure is mild, your doctor may prescribe cardiac rehabilitation. During a cardiac rehabilitation program, you will learn how to manage your disease and exercise safely.

A diagnosis of heart failure also means lifestyle changes.

Remember, lifestyle changes don’t happen overnight. Talk to your doctor if you need help identifying where and how to start.

Your doctor may recommend some or all of the following lifestyle changes:

  • little or no alcohol
  • no smoking
  • stress management
  • low sodium diet
  • water restriction
  • adequate sleep
  • exercise, as determined by your healthcare team

Your doctor may also prescribe medication to control blood pressure. This can include a combination of:

  • beta blockers
  • mineralocorticoid receptor antagonist
  • angiotensin receptor blocker and neprilysin inhibitor
  • sodium-glucose co-transporter 2 inhibitor

You may need treatments such as heart surgery, an automatic implantable defibrillator, or a mechanical heart pump. In severe cases, a heart transplant is an option of last resort.

Heart failure is a serious illness that must be managed for the rest of your life.

Seek immediate medical attention if you develop symptoms such as shortness of breath, unusual fatigue, cough, or shortness of breath when lying down.

Several easily tolerated tests can be done to determine how strong your heart is and whether lifestyle changes, medications, or other treatments are needed to keep your heart pumping for a long time.


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