Why did my cardiologist diagnose Congestive Heart Failure?
During the last 5-years my GP (board certified Internal Medicine physician) and Cardiologists (three - all board certified and in same practice) have told me I have Congestive Heart Failure. None of them have been able to tell me what test results or examination results lead to that diagnosis.
I am 77-years old and in relatively good health other than metastatic prostate cancer and well controlled hypertension (130/75 on 12.5 mg Metoprolol). I have been a very serious runner and bicycle rider my entire life. I have never smoked, drink very little alcohol, and eat no red meat and very little processed food.
I engage in strenuous physical activity for at least 90-minutes per session five times a week. My heart rate averages over 110 during the exercise and I can comfortably keep the HR at 130 for many minutes at a time. I never have a shortness of breath, chest or arm pains, or any sense of discomfort. My HR drops to 70 within 2-minutes of sitting down. My resting HR, just prior to getting out of bed is 50 - 52 bpm.
I have had many nuclear stress tests and echo cardiograms during the last 20-years. My ejection fraction is 62% to 65% in every test.
My lipids are all in the low normal range and have not varied 5% during the last 30-years. The most recent cardiology exam resulted in a diagnosis of hyperlipidemia but my most recent lipid panel shows: Triglyceride mg/dL was 78, HDL 55, LDL 45, total cholesterol 116.
My PRO BNP blood test was 28 in 2014 and 98 in 2020.
The only thing the cardiologist mentions as indicative of Congestive Heart Failure is Coronary Hypertrophy and an enlarged aorta. I reminded her this is a long term indicator first noted over 25-years ago. In 1999 an echocardiogram noted: Aortic root diameter of 4.0 cm. The LA diameter was 4.1 cm, LVIDd was 4.7 cm and LVIDs 3.1 cm.
Three more recent cardiograms, in 2014, 2020 and 2024 reported the exact same measurements.
A cardiac angiogram in summer 2023 found one coronary artery was 40% blocked. But, the hemodynamics showed excellent flow and pressure and the cardiologist chose to not insert a stent. A CT with contrast Angiogram in March 2025 found exactly the same blockage. No other blockages of note were reported.
I have none of the Congestive Heart Failure symptoms shown on various web sites. Is there some other objective test I can request?
What impact would Congestive Heart Failure have on my life with the test results I describe and the total lack of symptoms?
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We appreciate you reaching out.
Unfortunately, we are not medical professionals and cannot comment on your test results nor your diagnosis from multiple doctors.
That being said, heart failure is a complex condition. The term heart failure doesn’t mean your heart has stopped beating. It is a condition in which the heart is unable to pump enough blood through the body. HF generally is caused by coronary artery disease, heart attack, or high blood pressure.
This article may provide some additional information: https://heart-failure.net/basics.
Wishing you all the best as you continue to search for answers,
Doreen (Team Member)OK - I understand. I have done extensive research on CHF. I have a graduate degree in neurophysiology and advanced multivariate statistics. I do understand much of the technical stuff I read about CHF.
I have just two questions for this community:
1) Is there any objective measure or test result to confirm a CHF diagnosis? I listed my test results because they all seem to deny a CHF diagnosis.
2) Is there any experience in this community with no symptoms and negative test results but still a CHF diagnosis five years after the initial diagnosis?,
We appreciate your questions and concern.
Hopefully others will chime in here with their personal experience.
In the meantime, these two articles may provide some interesting information (in case you haven't caught them already): https://heart-failure.net/diagnosis and https://heart-failure.net/types. Wishing you all the best in your search for answers. ~Doreen (Team Member)
Thanks for the article links. I have read dozens of primary research articles and have learned a great deal more since my first post here.
I am beginning to understand what my cardiologist was thinking when she told me I had Congestive Heart Failure.
Looking at ACC/AHA Heart Failure Stages I I have the following risk factors that lead to a CHF diagnosis:
Coronary Vascular Disease: one coronary artery is 40% blocked
Obese: BMI of 31 (I was running 6x7' miles 5 times a week for most of my adult time with a BMI>29 so wonder about this factor. My recent Bruce Protocol Stress was stopped at 14' while I still was running easily)
AFIB: Six ER visits with tachycardia and hypertension (nine-ER docs and/or cardiologists cannot agree if it is AFib, Exercised Induced Tachycardia, SVT, PVC)
Ventricular Hypertrophy (4 cm aorta and "concentric left ventricular hypertrophy" first noted 17-years ago so it is hard to understand this as a risk factor)
Edema: (right ankle and foot ONLY when I go more than 48-hours with no strenuous exercise)
My contra-indicators of low triglycerides, good EF, low Natriuretic Peptides do not offset the risk factors listed above. This is my new "learned" fact that was confusing me previously.
I am asymptomatic (NYHA Stage 0) but with that set of factors I appear to (AHA classification) "pre-HF" Stage B with HFpEf.
I wish my cardiologist had taken the time to explain a little more. We have had involved technical discussions about coronary electro-physiology and a lot about calcium channels and conduction. She knows me pretty well and should have understood that I needed more detail.
The really interesting detail for me is the CHF and ASCVD online calculators. For example MAGICC shows a 13% probability of a 3-year mortality. The ONLY factor I can reduce that results in a lower mortality is my AGE. Reducing BP, BMI, creatine does not improve my survival.
The Framingham Risk Score is 17% at 10-years. If I could lower my BP from 130 to 120 the Risk Score only drops to 16%. Again, only getting younger will reduce my risk of coronary problems. The Framington Heart Failure model shows the same thing - once older than 75 and asymptomatic for exercise stress - getting younger is about the only thing that reduces risk over the subsequent years.
My doc has me on hypertensives and a statin substitute as well as a diuretic so I guess we are doing all that can be done.
I will continue to exercise hard and keep my weight and BP headed downward.
I found cardiologist don't understand heart failure symptoms. I had to go to a Heart Failure Specialist but by then I was put on hospice care.. so find a HF Specialist. Also Google explained a lot of my symptoms to me- very helpful. ,
Thank you for joining the conversation and sharing your experience.
How are you doing today?
Please know my thoughts are with you.
Warmly, Doreen (Team Member)
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