How Is Heart Failure Diagnosed?
Our heart is much stronger than the needs we averagely place on it every day. This means, when it starts to fail, it can compensate for any loss of pumping ability for a time by enlarging, developing more muscle or beating faster. The body also helps by diverting blood away from less vital organs to keep supply consistent to the heart and brain. Eventually however the burden starts to overwhelm the heart and the first symptoms of heart failure will appear. All this means that by the time someone receives a diagnosis of heart failure, their heart may have been failing for some time, even though the patient might feel like it just suddenly happened. The initial evaluation of heart failure starts with a doctor who will carry out a physical examination and discusses the patient’s symptoms. If she suspects there is a problem, she will order some diagnostic tests, to take a closer look at the heart.
Note: There is no common accepted definition of heart failure and it appears to be a syndrome (a cluster of symptoms with multiple causes) rather than a disease in itself.
What Does The Doctor Do?
Your doctor will:
• Discuss your symptoms and take a complete medical history.
• Measure your heart rate and take a blood pressure reading.
• Perform a physical examination looking for any signs of swelling in your legs or ankles indicating fluid retention. She will press down on the skin to see how long any indentations last. If they last a few minutes this is known as pitting edema.
Check for signs of blueness in the skin (called
cyanosis) which may be accompanied by moisture and coolness. It most often occurs in the toes and fingers and indicates low levels
of oxygen in the blood (called hypoxia).
• Use a stethoscope to listen to the lungs. A crackling sound will indicate fluid on the lungs. The doctor will listen to your breathing or
thump your chest, this is one way to tell if
fluid from the lungs has leaked (pleural effusion) into
the chest cavity. The fluid will also appear as a cloudy
area on X-rays.
• Use a stethoscope to listen for a rapid heartbeat or heart murmur.
• Check the veins on your neck for signs of enlargement.
What Tests Will Be Performed?
If the physician detects possible signs of heart failure she will order diagnostic tests to determine if your symptoms are caused by the heart. These tests are reasonable to perform as many symptoms of heart failure can overlap with other diseases. The following tests are often used for heart disease testing and include:
An electrocardiogram (image) or ECG can detect abnormal heart rhythms as well as any thickening of the heart wall and signs of previous heart attacks. Damage from heart attacks is one of the possible causes of heart failure. Although it may be difficult to believe it is estimated that 3 to 4 million Americans have a heart attack every year and don't know it. This phenomena is known as silent heart attacks.
An echocardiogram (image) or echo uses ultrasound technology to measure the size of the heart and to view the pumping action of the heart. It is the same technology used during a pregnancy ultrasound to see a baby. An echo is the most common test for heart failure and it can highlight specific areas of the heart that are not working well. It can distinguish between systolic and diastolic failure (left and right sided failure). A person with severe systolic heart failure will have a heart volume (ejection fraction) of about 15 to 20 percent. A healthy person should be around 55 to 65 percent and someone with diastolic heart failure will be abnormally high, over 65 percent.
A chest X-ray may be ordered to check for signs of an enlarged heart or fluid buildup in the lungs.
Exercise Stress Testing
An exercise stress test (image) which combines an ECG with some form of exercise may be used to determine if the symptoms are coming from the heart. The exercise is usually carried out on a treadmill or exercise bike.
Nuclear Image Test
Also known as a nuclear stress test (image), this procedure may be needed to assess the overall function of your heart, including its pumping action.
Magnetic Resonance Imaging
Occasionally an MRI scan will be ordered to help get a better picture of the heart and its overall state of health.
Right Heart Catheterization
Many patients are familiar with cardiac catheterization to assess the health of the arteries supplying blood to the heart (coronary arteries). However, a slightly different type of test is called a right heart catheterization which can be carried out to evaluate patients with severe heart failure. While this test, as well as nuclear imaging, is not typically needed to diagnose heart failure, it can help doctors identify possible causes for the condition which may then be treated.
Is There A Blood Test?