Diagnosis Heart Failure: Physical Exam

A complete medical history and physical exam are the cornerstones in the clinical assessment of people with heart failure (HF).^1-2 Important information gathered through history can identify both heart-related and non-heart related conditions that can contribute to or speed up the onset or progression of HF.²

History

A thorough medical history can offer a provider clues on the underlying cause of heart failure, including a familial link. Research shows that genetics may play a role as familial syndromes occur in more than 20% of people diagnosed with heart failure. The guidelines now call for 3-generation family history.²

Clinical component

The physical exam provides information about the severity of illness and allows your doctor to look at you, listen to your body, and listen to what you have to say. Imaging technology and diagnostic laboratory testing are useful and should be considered supporting diagnostic tools, alongside a good clinical exam.²

What to expect when you see your provider

Your provider will start by talking to you about your family history. Has anyone in your family ever had heart disease? This would include parents, siblings, aunts/uncles, and grandparents. A good history will consider the presence of any heart disease throughout your family. In addition to talking about heart disease, tell your doctor about any family history of smoking, diabetes, kidney, or metabolic diseases.²

You may be asked to complete forms with all your medical information before you see the provider. This will help the provider to know what to look for during the exam. This includes all medical conditions, symptoms, and lifestyle habits like tobacco and alcohol use.³ It is a good idea to be prepared with all of the information by writing it down in advance and being able to take notes on any questions you have during your office visit. Be sure to bring a list of all the prescription medications, vitamins, supplements, and over the counter drugs you take. Your provider may recommend changes in your regimen based on the diagnosis and recommended treatment plan.³

The provider will evaluate your weight, blood pressure, heart and lung sounds, and any evidence of swelling. The doctor will use a stethoscope to listen to the heart and lungs for any abnormal sounds or signs of congestion. The doctor will check for fluid buildup in the feet, ankles, legs, and abdomen.^1-2 Another area the doctor will examine is the jugular vein in the neck. If there is increased pressure the vein will bulge, indicating the presence of fluid buildup. They may also check for signs of an enlarged liver, hepatomegaly, which can be an indicator of underlying medical conditions like liver disease, congestive heart failure, or cancer.⁴

Symptoms

It is important to tell your healthcare provider about all the symptoms you have experienced. Some classic symptoms of heart failure include:^1-3,5

• Dyspnea - shortness of breath with exertion or when lying down
• Fatigue and weakness - feeling generally tired and difficulty keeping up with everyday activities
• Persistent cough or wheezing – producing white or pink blood-tinged mucus
• Edema - swelling in the abdomen or lower extremities including the legs, ankles, and feet due to a buildup of extra fluid
• Arrhythmia – experiencing palpitations, having a rapid or irregular heartbeat
• Lack of appetite and nausea – feeling full, bloated or sick to your stomach
• Confusion – having difficulty concentrating or disorientation.

Be honest. It is important to share all the information necessary to assess your risk for or effectiveness in treating heart failure. Tell the healthcare team if you smoke, drink, eat a high-fat diet, and whether or not you exercise.² Without complete information is hard to make an accurate diagnosis.

Tests

During your visit, you will generally receive a 12-lead EKG.² This will provide information on the electrical activity of the heart including any rhythm problems or muscle tissue damage. Many providers will do the EKG at each visit.

Blood and urine lab tests will provide additional information to providers. These tests may include a complete blood count (CBC), urinalysis, serum electrolytes (like potassium, calcium, and magnesium), blood urea nitrogen, serum creatinine, glucose, fasting lipid profile, liver function tests, and thyroid-stimulating hormone. If you have or your provider suspects other underlying medical conditions like arthritis, diabetes, or kidney dysfunction your provider may order additional tests.^2,6

Regular checkups

If you have heart failure, make sure to have regular checkups. Good management of your condition can help delay disease progression. Managing HF can involve medications and lifestyle choices, including diet and exercise. Symptoms of heart failure often fluctuate; call your healthcare team if you experience a sudden change or increase in the number of symptoms.⁶