Diagnosis of Congestive Heart Failure (CHF)

The first step your doctor will take to assess whether you have CHF is to discuss your medical history and conduct a complete physical exam. Afterwards, your doctor may recommend some or all of the following tests to make the diagnosis and assess the degree of damage:

Chest X-ray—An x-ray image will show whether the heart is enlarged, or congestion is present in the lungs.

Blood Tests—To check for anemia, thyroid disease, elevated cholesterol and blood lipids, and to evaluate kidney and liver function, electrolytes, and calcium and magnesium levels. In addition, your doctor will check plasma levels of BNP (brain natriuretic peptide) as those are elevated in patients with heart failure.

Electrocardiogram (EKG or ECG)—Records the electrical activity of your heart through electrodes attached to the skin. This test will help diagnose heart rhythm problems and damage to the heart from a heart attack .

Echocardiogram—Uses sound waves to produce an image of the working heart. This test helps evaluate the function of the valves and chambers of the heart and determines the amount of blood ejected from the heart with each heartbeat (ejection fraction). An echocardiogram also can detect structural damage, tumors, or excess fluid around the heart.

Exercise Stress Test—Records the heart's electrical activity during increased physical activity. It may be coupled with echocardiogram. Patients who cannot exercise may be given medication intravenously that simulates the effects of physical exertion.

Coronary Catheterization—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.

Coronary Angiography—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 angina .

Nuclear Scanning—Radioactive material (such as value) is injected into a vein and observed as it is absorbed by the heart muscle. Areas with diminished flow (and uptake of the radioactive material) show up as dark spots on the scan.

Electron-beam CT Scan (CT Angiography)—A type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures. This type of CT scan detects calcium and cholesterol deposits in the coronary arteries. Based on that and other health information, your doctor will attempt to determine the risk of heart disease, including heart attacks. The American Heart Association published guidelines in 2006, indicating that heart scans are not for everyone and those most likely to benefit from the procedure are patients with intermediate risk of coronary artery disease.

Cardiac Magnetic Resonance Imaging—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. It is also helpful in measuring ejection fraction and evaluating patients for the presence of cardiomyopathy.

Diagnostic Indicators

As your doctor examines you, he or she will be looking for some characteristic signs of CHF on the physical exam, including:

  • Sound of fluid in the lungs (rales)
  • Enlargement of the jugular vein in the neck (jugular venous distention)
  • Enlargement of the liver (hepatomegaly)
  • High blood pressure (hypertension)
  • Low blood pressure (hypotension)
  • Fast heart rate (tachycardia)
  • Edema (swelling of the ankles, legs, feet)
  • Fluid in the abdominal cavity ( ascites )
  • Fluid in the space between the lungs and ribs ( pleural effusion )

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

Hunt SA, Abraham WT, Chin MH, et al. For: American College of Cardiology/American Heart Association Task Force on Practice Guidelines. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. Circulation. 2005;112:e154.

Lima JA, Desai MY. Cardiovascular magnetic resonance imaging: current and emerging applications. J Am Coll Cardiol. 2004;44:1164.

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

Redfield MM, Rodeheffer RJ, Jacobsen SJ, et al. Plasma brain natriuretic peptide to detect preclinical ventricular systolic or diastolic dysfunction: a community-based study. Circulation. 2004;109:3176.



Last reviewed June 2008 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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