Although heart failure is a clinical diagnosis, made after an assessment of the patient’s history and a physical exam, many tests can help to further evaluate it.
An echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image.
Using this test, your doctor finds out about the pumping or squeezing function of your heart, how your heart relaxes and fills, the function of your heart valves, and the size of your heart.
An echocardiogram (Echo) is the best test to:
Identify which type of heart failure (systolic versus diastolic, valvular)
Monitor your heart failure and guide your treatment
Heart failure can be diagnosed if the echocardiogram shows that the pumping function of the heart is too low. This is called an ejection fraction. A normal ejection fraction is around 55 - 65%.
Other Imaging Tests
Several other imaging tests can look at how well your heart is able to pump blood and how much heart muscle damage is present.
A chest x-ray may be done in your doctor's office when your symptoms suddenly become worse, but it cannot diagnose heart failure.
Ventriculography is another test that measures the overall squeezing strength of the heart (ejection fraction). It can also identify if one part of the heart muscle is moving poorly. This may mean that there is a blockage in the artery of the heart that delivers blood to the damaged part. It uses x-ray contrast fluid to fill the pumping chamber of the heart and evaluate its function. It is usually done at the same time as other tests, such as coronary angiography.
MRI of the heart may be done to check for how much heart muscle damage is present.
Stress tests are done to see whether your heart muscle is getting enough blood flow, and therefore enough oxygen, when it is working hard (under stress).
Nuclear stress test
Exercise stress test
If you are having angina, or any of the above tests show that narrowing of one of your heart arteries could be causing your heart failure to get worse, your doctor may order a heart catheterization.
Many different blood tests are used to:
Help diagnose and monitor heart failure
Identify risk factors for heart disease
Look for possible causes of heart failure, or problems that may make your heart failure your worse
Monitor for side effects of medications you may be taking
Blood urea nitrogen (BUN) and serum creatinine tests help monitor how well your kidneys are working. These tests will be ordered on a regular basis:
If you are taking medicines called ACE inhibitors or ARBs (angiotensin receptor blockers)
When your doctor changes the dosage of these and other medicines
If you have more severe heart failure
Sodium and potassium levels in your blood will need to be measured on a regular basis and if some medicines are changed.
ACE inhibitors, ARBs, or certain types of water pills (amiloride, spironolactone, and triamterene) can make your potassium levels too high.
Most other types of water pills can make your sodium too low or your potassium too high.
Since anemia, or low red blood cell count, can make your heart failure worse, your doctor will check your CBC or complete blood count on a regular basis or when your symptoms become worse.
Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009 Apr 14;119(14):1977-2016. Epub 2009 Mar 26.
Mann DL. Management of heart failure patients with reduced ejection fraction. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 28.
Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.