Heart Failure - Diagnosis - Diagnosis

Your doctor will diagnose heart failure based on your medical history, a physical exam, and test results. Your doctor may also refer you to a cardiologist for these tests and treatment. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases. 

Medical history and physical exam 

Bring a list of your symptoms to your doctor’s appointment, including how often they happen and when they started. Also, bring a list of any prescription and over-the-counter medicines you take. Let your doctor know if you have any risk factors for heart failure. 

During your physical exam, your doctor will: 

  • Measure your heart rate, blood pressure, and body weight. 
  • Listen to your heart with a stethoscope for sounds that suggest that your heart is not working properly. 
  • Listen to your lungs for the sounds of fluid buildup. 
  • Look for swelling in your ankles, feet, legs, liver, and veins in your neck. 

Diagnostic tests and procedures 

Blood tests 

Your doctor may order blood tests to check the levels of certain molecules, such as brain natriuretic peptide (BNP). These levels rise during heart failure. Blood tests can also show how well your liver and your kidneys are working. 

Tests to measure your ejection fraction 

Your doctor may order an echocardiography (echo) or other imaging tests to measure your ejection fraction. Your ejection fraction is the percent of the blood in the lower left chamber of your heart (the left ventricle) that is pumped out of your heart with each heartbeat. Ejection fraction tells your doctor how well your heart pumps. This helps your doctor diagnose the type of heart failure you have and guide your treatment. 

  • If 40% or less of the blood in your left ventricle is pumped out in one beat, you have heart failure with reduced ejection fraction. 
  • If 50% or more of the blood in your left ventricle is pumped out in one beat, you have heart failure with preserved ejection fraction. 

If your ejection fraction is somewhere in between (41% to 49%), you may be diagnosed with heart failure with borderline ejection fraction. 

Other tests 

  • Other imaging tests to show how well your heart is working, such as a cardiac CT scan, cardiac MRI, or nuclear heart scan. To look inside the arteries in your heart to see if they are blocked, you may also need cardiac catheterization with coronary angiography. 
  • Tests for your heart’s electrical activity, including an electrocardiogram (EKG) or a Holter or event monitor that you wear for 24 to 48 hours or longer while going about your normal activities. 
  • A stress test to measure how much exercise your body can handle and how well it works during physical activity. Some heart problems are easier to diagnose when your heart is working hard and beating fast.