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How Is Heart Failure Diagnosed?

Heart failure (HF) is defined by the American Heart Association and American College of Cardiology as a complex clinical syndrome, resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.1 The American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) have developed guidelines on the diagnosis of heart failure.2 A diagnosis of heart failure is generally made based on clinical findings from a thorough medical history and a physical exam. There is no single diagnostic test for HF and there is no cure.2

Heart failure is a common condition, especially in the aging population. It is characterized by symptoms of dyspnea (shortness of breath), fatigue, and edema – signs of fluid retention – swelling of ankles, feet, and abdomen. Heart failure symptoms typically develop when the heart has difficulty pumping enough oxygenated blood throughout the body to support its metabolic demands.2

If your healthcare provider suspects you may have heart failure, there are multiple steps they will take to make a diagnosis. The first step is a physical exam in the office. At that time, they may order some tests to help confirm or rule out their suspicions.2 An early HF diagnosis increases the likelihood that you may be able to manage your heart failure and live a longer, more productive, and active life.

Talk to your healthcare provider

When you visit your healthcare provider, be sure to tell them about your symptoms and your medical history. Describing how you feel, when the symptoms began, how often and under what circumstances they occur, how long they last, and what you feel can help your healthcare provider determine if your symptoms are from a cardiac condition or another underlying medical condition.3-4

A thorough medical history that includes your personal illnesses and conditions, as well as any family history of heart or lung problems, high blood pressure or thyroid dysfunction, diabetes, or other conditions that could affect heart health, are important pieces of the diagnostic puzzle.3

Diagnostic tests

There are several tests that may be completed as part of the diagnostic process. Testing can provide insights into the reason you are experiencing symptoms. Testing can measure the heart’s pumping ability and whether the ventricles, the lower chambers of the heart, are causing heart failure symptoms. Tests can also reveal any chemical imbalances, history of heart attack or diseases of the heart, lungs, and kidneys which could also lead to the development of heart failure. They can also help identify alternative and potentially reversible causes of heart failure.1,4

Some common diagnostic tests for heart failure include blood work, urinalysis, and imaging tests. The various blood tests may include an evaluation of cardiac enzyme levels and biomarkers, kidney and thyroid function, as well as brain natriuretic peptide (BNP) levels. Cardiac imaging can be critical in the diagnosis of HF and in selecting a course of treatment.5-6

Imaging Tests can provide doctors with information on the electrical activity of the heart, its structure, and any abnormalities. These can include different kinds of images gathered from chest x-rays, electrocardiogram (EKG or ECG), echocardiogram (ultrasound), exercise stress test, cardiac cat scan, MRI, and multiple-gated acquisition scan (MUGA).5-6

Early diagnosis of heart failure is important to successfully identify the presence of contributing factors that can be modified in some people to prevent further deterioration.3

Written by: Linda Minton | Last reviewed: November 2019
  1. King M, Kingery J, Casey B. Diagnosis and evaluation of heart failure. Am Fam Physician. 2012;85:1161-1168
  2. ACCF and AHA Release Guidelines on the Management of Heart Failure. Am Fam Physician. 2014 Aug 1;90(3):186-189.
  3. Shamsham F. Mitchell J. Essentials of the diagnosis of heart failure. Am Fam Physician. 2000 Mar 1;61(5):1319-28.
  4. Heart Failure. Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148. Accessed 10/4/19.
  5. Diagnosing Heart Failure. American Heart Association. Available at: https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure. Accessed 10/3/19.
  6. Common Tests for Heart Failure. American Heart Association. Available at: https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/common-tests-for-heart-failure. Accessed 10/3/19.