For Your Patients: How Is Heart Failure Diagnosed?

— A brief overview of what tests, exams, and questions to expect

Illustration of a stethoscope with an electrocardiogram in a circle over a heart in failure

When signs point to heart failure, your physician will ask a number of questions, do a physical exam, and use a variety of tests to make a definitive diagnosis.

One of the key questions you might expect is what symptoms you've been having. In advance of your appointment, you might try to make a list of these for yourself and discuss them with a loved one -- particularly regarding the frequency and circumstances in which you feel shortness of breath, a racing heart, or chest pain.

Your medical history will also be important for the care team to know, including what doctors have diagnosed you with in the past and any recent events like heart attack, hospitalization, or pregnancy. Your doctor will check on common risk factors for heart failure, such as high blood pressure, coronary artery disease, and diabetes.

When it comes to the physical exam, your physician will be looking for signs of swelling in your ankles, feet, legs, or stomach area -- called edema -- and if veins in your neck bulge. A stethoscope may be used to listen to your lungs for telltale sounds of fluid buildup (lung congestion) and to your heart for specific sounds (murmurs) that suggest blockages, a heart valve that isn't closing properly, or other problems.

Diagnostic tests may include:

  • Blood tests
  • Chest x-ray
  • An echocardiogram to show the size and structure of the heart as it pumps blood
  • An electrocardiogram in the office to look at electrical activity of the heart, including the timing and length of specific parts of the cycle of motions that make up a heart beat
  • Cardiac magnetic resonance imaging or cardiac computerized tomography for detailed imaging of the heart
  • A stress test to monitor the heart while it's beating faster due to exercise or a stimulating medication
  • Cardiac catheterization, a procedure using a small flexible catheter wire threaded through a blood vessel in your wrist or groin to your heart, sometimes with the use of dye to make the images clearer
  • Coronary angiography, which may be needed in certain cases to take a small sample of heart muscle to look for specific causes of heart failure

With all these facts together, your physician can define the type and severity of heart failure you have, which will help you get the best treatment and a better picture of what to expect in the future with your condition.

Read Part 1 of this series: For Your Patients: What Is Heart Failure?

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.