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Medical Author:

Terrence X O'Brien, MD, FACC

Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Congestive heart failure CHF can be confused with other illnesses that cause breathing difficulties, such as bronchitis, pneumonia, emphysema, and asthma. Talking to a medical professional, along with receiving a physical exam and tests available only at a medical office or hospital, are necessary to make an definitive diagnosis. Some of the most useful tests are mentioned below.

Chest X-ray: This is very helpful in identifying the buildup of fluid in the lungs. Also, the heart usually enlarges in congestive heart failure, and this may be visible on the X-ray film. In addition, other disorders may be diagnosed.

• An electrocardiogram (ECG, EKG) is a painless test that measures the electrical activity (rhythm) of the heart. For this test, which takes just a few minutes, one lies on a table with electrodes attached to the skin of the chest, arms, and legs. The ECG can reveal several different heart problems that can cause heart failure, including heart attacks, rhythm disorders, long-standing strain on the heart from high blood pressure, and certain valve problems.
• However, the ECG result may be normal in heart failure.

Blood tests: People may have blood drawn for lab tests.

• Low blood cell counts (anemia) may cause symptoms much like congestive heart failure or contribute to the condition.
• Sodium, potassium, magnesium, and other electrolyte levels may be abnormal, especially if the person has been treated with diuretics and/or has kidney disease.
• Tests for kidney function.
• B-type natriuretic peptide (BNP) can be measured. This is a hormone produced at higher levels by the failing heart muscle. This is a good screening test; the levels of this hormone generally increase as the severity of heart failure worsens.

Echocardiogram (ECG, EKG): This is a type of ultrasound that shows the beating of the heart and the various cardiac structures. It is safe, painless, and one of the most important tests for diagnosing and following patients with heart failure over time.

• An echocardiogram can be useful in determining the cause of heart failure (such as problems with the muscle, valves, or pericardium) and it provides an accurate measurement of the left ventricle's ejection fraction, an important measure of the heart's pumping function.
• In multiple-gated acquisition scanning (MUGA scan), a small amount of a mildly radioactive dye is injected into a vein and travels to the heart. As the heart pumps, pictures are taken. The pumping performance of the left and right ventricles can then be determined from these pictures. This test is used far less often than echocardiography.

Stress testing: A treadmill or medication (nonwalking) stress test is used to help evaluate the cause or causes of heart failure, in particular, regarding coronary artery disease. This test is frequently combined with nuclear imaging or echocardiography to improve accuracy. Stress testing is commonly performed and is a cornerstone of diagnostic cardiology.

MRI (Magnetic resonance imaging):

• Magnetic fields are used to provide images of the structure of the heart and its ability to pump blood to the body.
• If used with a special MRI contrast agent (gadolinium), it can provide information about inflammation, injury, and blood flow to the heart.

Cardiac catheterization (cath): During this procedure, a small tube is inserted into and artery in the leg or arm. The catheter is moved to the heart to measure pressures inside the heart and to put contrast into the coronary arteries to look for blockages.

• Although this test is invasive, it is common and considered the “gold standard” for diagnosing coronary artery disease as well as for measuring various pressures in the heart and diagnosing certain disorders of the heart valves.

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