Heart Failure

To diagnose heart failure, your health care provider examines you and asks questions about your symptoms and medical history. Your provider checks to see if you have risk factors for heart failure, such as high blood pressure, coronary artery disease or diabetes.

Your care provider listens to your lungs and heart with a device called a stethoscope. A whooshing sound called a murmur may be heard when listening to your heart. Your provider may look at the veins in your neck and check for swelling in your legs and belly.

Tests

Tests that may be done to diagnose heart failure may include:

• Blood tests. Blood tests can help diagnose diseases that can affect the heart. Blood tests also can look for a specific protein made by the heart and blood vessels. In heart failure, the level of this protein goes up.
• Chest X-ray. X-ray images can show the condition of the lungs and heart.
• Electrocardiogram (ECG or EKG). This quick and painless test records the electrical signals in the heart. It can show how fast or how slowly the heart is beating.
• Echocardiogram. Sound waves create images of the beating heart. This test shows the size and structure of the heart and heart valves and blood flow through the heart.
• Ejection fraction. Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. This measurement is taken during an echocardiogram. The result helps classify heart failure and guides treatment. An ejection fraction of 50% or higher is considered ideal. But you can still have heart failure even if the number is considered ideal.
• Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. Exercise tests can show how the heart responds to physical activity. If you can’t exercise, you might be given medicines.
• CT scan of the heart. Also called a cardiac CT scan, this test uses X-rays to create cross-sectional images of the heart.
• Heart MRI scan, also called a cardiac MRI. This test uses magnetic fields and radio waves to create detailed images of the heart.
• Coronary angiogram. This test helps spot blockages in the heart arteries. The health care provider inserts a long, thin flexible tube called a catheter into a blood vessel, usually in the groin or wrist. It’s then guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.
• Myocardial biopsy. In this test, a health care provider removes very small pieces of the heart muscle for examination. This test may be done to diagnose certain types of heart muscle diseases that cause heart failure.

During or after testing for heart failure, your health care provider may tell you the stage of disease. Staging helps determine the most appropriate treatment. There are two main ways to determine the stage of heart failure:

New York Heart Association (NYHA) classification

This system groups heart failure into four categories by number. You may see Roman numerals used for these category names.

• Class 1 heart failure. There are no heart failure symptoms.
• Class 2 heart failure. Everyday activities can be done without difficulty. But exertion causes shortness of breath or fatigue.
• Class 3 heart failure. It’s difficult to complete everyday activities.
• Class 4 heart failure. Shortness of breath occurs even at rest. This category includes the most severe heart failure.

American College of Cardiology/American Heart Association classification

This stage-based classification system uses letters A to D. It includes a category for people who are at risk of developing heart failure.

• Stage A. There are several risk factors for heart failure but no signs or symptoms.
• Stage B. There is heart disease but no signs or symptoms of heart failure.
• Stage C. There is heart disease and signs or symptoms of heart failure.
• Stage D. Advanced heart failure requires specialized treatments.

Health care providers often use the classification systems together to help decide the most appropriate treatment options. Your provider can help you interpret your stage.