Overview

Diagnosis

Diagnosing heart failure begins with a detailed medical evaluation. Your healthcare professional will review your symptoms, medical history, and risk factors such as high blood pressure, coronary artery disease, or diabetes. During a physical exam, your care provider listens to your heart and lungs using a stethoscope. Murmurs, fluid in the lungs, or swelling in the legs and abdomen can indicate heart failure.

Several diagnostic tests help confirm the condition and assess its severity.

Common diagnostic tests for heart failure include:

  • Blood tests: These detect diseases affecting the heart and measure proteins produced by the heart and blood vessels. Elevated levels of certain proteins can signal heart failure.

  • Chest X-ray: Provides images of the heart and lungs to check for enlargement or fluid buildup.

  • Electrocardiogram (ECG or EKG): Records the heart’s electrical signals to reveal irregular rhythms or heart damage.

  • Echocardiogram: Uses sound waves to create moving images of the heart, showing its size, structure, and blood flow.

  • Ejection fraction: Measures how much blood the heart pumps out with each beat. A healthy ejection fraction is 50% or higher.

  • Exercise or stress tests: Monitor the heart’s response to physical activity on a treadmill or stationary bike. Medication may be used if you cannot exercise.

  • CT scan of the heart: Produces cross-sectional X-ray images of the heart to assess structure and detect blockages.

  • Heart MRI scan: Uses magnetic fields and radio waves to provide detailed images of the heart’s muscles and chambers.

  • Coronary angiogram: Involves inserting a catheter and injecting dye into the arteries to detect blockages.

  • Myocardial biopsy: A small tissue sample is taken from the heart muscle to diagnose specific heart muscle diseases.

Once testing is complete, your healthcare provider may classify the stage of heart failure to guide treatment.

The two most common classification systems are:

New York Heart Association (NYHA) Classification

  • Class 1: No symptoms of heart failure.

  • Class 2: Mild symptoms during exertion.

  • Class 3: Noticeable symptoms with daily activities.

  • Class 4: Symptoms even at rest; most severe stage.

American College of Cardiology/American Heart Association (ACC/AHA) Classification

  • Stage A: Risk factors present but no symptoms.

  • Stage B: Heart disease present but no symptoms.

  • Stage C: Heart disease with symptoms.

  • Stage D: Advanced heart failure requiring specialized care.

These systems are often used together to determine the best treatment approach.

Treatment

Treatment for heart failure depends on the cause and severity. The main goals are to relieve symptoms, slow disease progression, and improve quality of life. Treatment usually includes lifestyle changes, medications, and in some cases, surgery or heart devices.

Lifestyle changes

Healthy habits play an important role in managing heart failure:

  • Limiting salt intake to reduce fluid retention

  • Eating a heart-healthy diet

  • Exercising under medical supervision

  • Maintaining a healthy weight

  • Managing stress and getting enough rest

  • Avoiding alcohol and quitting smoking

Medications

A combination of medications is often prescribed to manage symptoms and improve heart function. These include:

  • ACE inhibitors: Relax blood vessels and lower blood pressure to reduce heart strain.

  • ARBs: Used when ACE inhibitors aren’t tolerated; they offer similar benefits.

  • ARNIs: A combination of sacubitril and valsartan helps reduce hospitalizations and improve heart performance.

  • Beta blockers: Slow heart rate, reduce blood pressure, and improve survival.

  • Diuretics: Help eliminate excess fluid and ease breathing.

  • Potassium-sparing diuretics: Used in severe heart failure to improve survival while maintaining potassium balance.

  • SGLT2 inhibitors: Originally for diabetes but now proven to lower heart failure-related deaths and hospitalizations.

  • Digoxin: Improves heart pumping and may slow the heart rate.

  • Hydralazine and isosorbide dinitrate: Relax blood vessels and reduce strain on the heart.

  • Vericiguat: Helps reduce the risk of hospitalization and death in high-risk heart failure.

  • Positive inotropes: Used intravenously in hospitals to help the heart pump more effectively.

Your healthcare provider may adjust your medications over time depending on how your condition responds.

Surgery or other procedures

Some people may need surgical treatments or devices to improve heart function:

  • Coronary artery bypass graft surgery (CABG): Restores blood flow by bypassing blocked arteries.

  • Heart valve repair or replacement: Corrects valve problems that contribute to heart failure.

  • Implantable cardioverter-defibrillator (ICD): Prevents life-threatening heart rhythms by delivering corrective shocks.

  • Cardiac resynchronization therapy (CRT): Coordinates heart chamber contractions to improve pumping efficiency.

  • Ventricular assist device (VAD): A mechanical pump that supports the heart, often used while awaiting transplant or as long-term therapy.

  • Heart transplant: Considered for severe cases when other treatments fail.

Symptom care and end-of-life care

When heart failure becomes advanced, symptom management and palliative care help improve comfort and quality of life. Hospice care may be recommended for end-of-life support, offering emotional, psychological, and spiritual assistance for both patients and families.

Discussing care preferences and advance directives with your healthcare team ensures your wishes are respected. In cases where an ICD is present, conversations about deactivating it may be appropriate to prevent unnecessary interventions at life’s end.

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