Congestive Heart Failure

Medically reviewed by Carina Fung, PharmD, BCPPS

Congestive heart failure diagnosis

In order to diagnose congestive heart failure39, your healthcare provider will review your medical history, listen to your symptoms, and perform a physical examination. This examination may include using a stethoscope to listen to your lungs for signs of congestion and detect abnormal heart sounds that may suggest the presence of heart failure.

Your provider will likely check for the presence of risk factors, such as high blood pressure, coronary artery disease, and diabetes. He or she may also examine the veins in your neck and check for a buildup of fluid in your abdomen and legs.

After performing a physical exam, your healthcare provider may also order the following tests:

  • Blood tests: Your provider may take a blood sample to look for signs of diseases that affect the heart. He or she may also check for the presence of a chemical called N-terminal pro-B type natriuretic peptide (NT-proBNP) if your diagnosis isn’t certain after other tests.
  • Chest X-ray40: X-ray images help show the condition of your lungs and heart. Your provider or a radiologist can also use an X-ray to diagnose conditions other than heart failure that may contribute to your signs and symptoms.
  • Electrocardiogram41 (ECG): This test measures the electrical activity, rate, and regularity of your heartbeat through electrodes attached to your skin. It helps your provider diagnose heart rhythm problems and damage to your heart.
  • Echocardiogram: An echocardiogram42 uses ultrasound (high-frequency sound waves) to produce a video image of your heart. This can help specialists see the size and shape of your heart, along with any abnormalities that may be present. An echocardiogram measures your ejection fraction, an important measurement of how well your heart is pumping that is used to help classify heart failure and guide treatment.
  • Stress test: Stress tests measure the health of your heart by how it responds to exertion. You may be asked to walk on a treadmill while attached to an ECG machine, or you may receive a drug intravenously that stimulates your heart similar to the way exercise does. Stress tests can sometimes also be done while wearing a mask that measures the ability of your heart and lungs to take in oxygen and expel carbon dioxide.
  • Cardiac computerized tomography (CT) scan: A cardiac CT scan43 uses an X-ray tube inside a machine that rotates around your body to collect images of your heart and chest.
  • Magnetic resonance imaging (MRI): A cardiac MRI44 produces a magnetic field that aligns atomic particles in some of your cells. Radio waves are broadcast toward these aligned particles, producing signals that create images of your heart.
  • Coronary angiogram45: In this test, a thin, flexible tube (called a catheter) is inserted into a blood vessel in your groin or arm and guided through the aorta into your coronary arteries. This test uses an injectable contrast dye to spot any blockage that may disrupt the flow of blood through the coronary arteries on an X-ray.
  • Myocardial biopsy: In this test, a small, flexible biopsy cord is inserted into a vein in your neck or groin, and small pieces of the heart muscle are taken. This test may be used to diagnose certain types of heart muscle diseases that cause heart failure.

Congestive heart failure prognosis

In one study46, the factors determining the prognosis in 100 patients with recent-onset CHF were evaluated. The study determined that the survival rates at 1, 3, 5, and 10-year markers in the entire group were 78.5%, 59.8%, 50.4%, and 14.7%, respectively.

The study found no correlations between age, sex, heart rate and cardiothoracic ratio, and the cumulative survival rate. However, it was determined that the prognosis of patients with congestive heart failure caused by underlying coronary artery disease or primary cardiomyopathy was poor compared to the prognosis of patients with other types of heart disease.

The study concluded that its results suggest that functional status, underlying heart disease, left ventricular stroke work, and the presence of ventricular tachycardia47 provide important information regarding the long-term prognosis in patients with congestive heart failure.

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