Table of ContentsView AllTable of ContentsSelf-ChecksPhysical ExaminationLabs and TestsImagingDifferential DiagnosisFrequently Asked QuestionsNext in Heart Failure GuideHow Heart Failure Is Treated
Table of ContentsView All
View All
Table of Contents
Self-Checks
Physical Examination
Labs and Tests
Imaging
Differential Diagnosis
Frequently Asked Questions
Next in Heart Failure Guide
Symptoms of heart failure (such as shortness of breath and swelling) can mimic those of other health issues. It’s important to bring such concerns to your healthcare provider’s attention, so they can determine whether heart failure or another condition is the cause.
A heart failure diagnosis is usually made based on your medical history, a physical examination, and heart function tests, primarilyelectrocardiogram(ECG or EKG) andechocardiogram(echo). Brain natriuretic peptide (BNP) measurement has gained attention because it can be done using a blood test. It can be used with an EKG and an echo to piece together a diagnosis of heart failure.
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Recognizing thesigns and symptoms of heart failurecan help you get tested and receive the medical attention you need early in the course of the illness before your condition worsens. These can be subtle at first and may progress slowly, so it is easy to ignore them or simply chalk them up to aging.
Knowing this, be sure to bring any of these concerns to your healthcare provider’s attention:
Also tell your healthcare provider if you experience the following symptoms along with those above:
Your healthcare provider will first assess your symptoms and ask how long you’ve had them. They’ll also ask about your medical history andrisk factors, particularly whether you’ve had any heart conditions, such as high blood pressure (hypertension),heart valve problems, an arrhythmia, or a heart attack.
They’ll ask what medications you take and determine if you have any lifestyle factors that can affect your heart, such as smoking, heavy drinking, or a poor diet. Your weight and blood pressure will be checked.
Then, your healthcare provider will listen to your heart and lungs using a stethoscope (this is called auscultation). Normally, you should have apattern of two heart soundswith every heartbeat. Heart failure often causes athird heart sound.Your lungs may sound congested on your lung examination if you have heart failure.
If you have edema, the practitioner may also check for pitting. They may look to see if there isclubbing in your fingersor if your nails are pale.
If you initially saw your primary care doctor, you might get a referral to acardiologistfor further testing.
If you have the signs and symptoms of heart failure, and your healthcare provider suspects the condition, they may run some tests to confirm a diagnosis.
EKG
The most common test used to assess heart function, an EKG is a non-invasive test that involves placing electrodes on the surface of the chest to measure the electrical activity of the heart. If you have any symptoms of heart disease, your healthcare provider is highly likely to order an EKG for you.
A visual representation (or tracing) of that activity is produced on a piece of paper or on a computer. Abnormal patterns on EKG, including the presence of Q waves, left bundle branch block, ST depression, left ventricular hypertrophy, andarrhythmias, can be seen in heart failure.
Natriuretic Peptide Tests
In healthy people, NT-proBNP levels are usually below 125 picograms per milliliter (pg/mL), and BNP levels are usually below 35 pg/mL.Elevated levels of these peptides may indicate heart failure.
Other Blood Tests
Some other blood tests can help contribute to the diagnosis and rule out other conditions. Tests that are typically ordered includeelectrolyte levels, cholesterol, glucose, blood counts, and tests to check thyroid, liver, and kidney function.
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Imaging tests can be helpful in visualizing anatomical and functional changes in the heart, as well as some changes in the lungs, which can differentiate heart failure from other cardiac and pulmonary problems. Several options may be considered.
X-Ray
A chest X-ray is a relatively quick imaging test that is often very helpful in diagnosing heart disease. Your chest X-ray may show thatyour heart appears enlargedor may show signs of congestion in your lungs if you have heart failure. If your healthcare provider is concerned about lung or heart problems, it is likely that you will have a chest X-ray.
Echocardiogram
An echocardiogram, often referred to as an echo, is a non-invasive ultrasound test that visualizes the heart while it is in action. A small probe is placed on your chest, which a technician will move to capture the action of your heart valves and chambers as your heart naturally cycles. Your echo can provide a great deal of information about your heart function.
In the setting of heart failure specifically, the thickness of your heart muscle, the filling and emptying of each chamber, and the heart rhythm are expected to be abnormal.Your healthcare provider may order an echocardiogram for you if you have a heart rhythm abnormality or a possible heart muscle abnormality.
Nuclear Imaging
These imaging tests, includingpositron emission test (PET)andsingle photon emission computerized tomography (SPECT), involve the injection of radioactive dyes. The heart will either take up or not take up these radioactive particles depending on how the heart muscle is functioning.
PET and SPECT are both used to assist in the diagnosis of heart conditions, including CAD and heart failure.
Stress Test
Your healthcare provider may consider a stress test if you have symptoms that are worse with exertion. Often, people with advanced heart failure cannot tolerate a stress test, but it may also identify early heart failure.
If you have symptoms of heart failure, your medical team may consider other conditions that also cause shortness of breath or swelling of the extremities. Most of the time, there are diagnostic tests that can differentiate between these conditions and heart failure. However, the diagnosis can become more complicated if you have heart failure as well as another medical condition.
Pulmonary embolus (PE): A PE, ablood clotin one of the blood vessels of the lungs, causes breathing difficulties and chest pain. The characteristics of these symptoms often differ between a PE and heart failure and can provide clues as to their cause. However, diagnostic testing is usually required to make the correct diagnosis. For conditions like PE and COPD, the BNP blood test can be particularly helpful in sorting out the cause of shortness of breath.
Kidney failure:Kidney failure, like heart failure, can take time to develop, causing progressively worsening symptoms. When kidneys do not function as they should, fatigue and edema of the legs and arms can develop, similar to heart failure. In general, kidney failure causes a change in electrolyte levels in the blood, which is not seen in heart failure.
Deep vein thrombosis (DVT):ADVTis a blood clot that often causes edema and may eventually cause a PE. A big difference between the edema of DVT and that of heart failure is that in DVT, the edema usually involves only one leg and it is not typically pitting. A DVT may cause a weak pulse in the affected limb and can be diagnosed with an ultrasound of the leg.
In the beginning you may not feel any different, but as the condition progresses you’ll begin to feel unusually tired and be short of breath (known asdyspnea) even after normal activity. You may also feel pain in your chest and experience heartpalpitations(fluttering, throbbing, or other odd sensations). These symptoms will become more pronounced over time, so that eventually you’ll notice them even when you’re resting.
The prognosis is quite variable, and depends on many factors such as your age, whether there is a treatable underlying cause, other medical conditions you may have, and how advanced the heart failure is at the time of diagnosis. Treatment for heart failure has advanced significantly over the past few decades, and studies show that the long-term prognosis has significantly improved over time.
How Heart Failure Is Treated
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Warning signs of heart failure.American Heart Association.Common tests for heart failure.Minami Y, Kajimoto K, Sato N, et al.Third heart sound in hospitalised patients with acute heart failure: Insights from the ATTEND study.Int J Clin Pract. 69(8):820-8. doi:10.1111/ijcp.12603Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012MedlinePlus.Natriuretic peptide tests (BNP, NT-proBNP).Inamdar AA, Inamdar AC.Heart failure: Diagnosis, management and utilization.J Clin Med. 5(7):62. doi:10.3390/jcm5070062National Heart Lung and Blood Institute.COPD.Merck Manuals Professional Version.Heart Failure (HF). New York Heart Association (NYHA) classification of heart failure.Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ.Trends in heart failure incidence and survival in a community-based population.JAMA. 2004;292(3):344-50. doi:10.1001/jama.292.3.344American Heart Association.Causes of heart failure.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Warning signs of heart failure.American Heart Association.Common tests for heart failure.Minami Y, Kajimoto K, Sato N, et al.Third heart sound in hospitalised patients with acute heart failure: Insights from the ATTEND study.Int J Clin Pract. 69(8):820-8. doi:10.1111/ijcp.12603Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012MedlinePlus.Natriuretic peptide tests (BNP, NT-proBNP).Inamdar AA, Inamdar AC.Heart failure: Diagnosis, management and utilization.J Clin Med. 5(7):62. doi:10.3390/jcm5070062National Heart Lung and Blood Institute.COPD.Merck Manuals Professional Version.Heart Failure (HF). New York Heart Association (NYHA) classification of heart failure.Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ.Trends in heart failure incidence and survival in a community-based population.JAMA. 2004;292(3):344-50. doi:10.1001/jama.292.3.344American Heart Association.Causes of heart failure.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Heart Association.Warning signs of heart failure.American Heart Association.Common tests for heart failure.Minami Y, Kajimoto K, Sato N, et al.Third heart sound in hospitalised patients with acute heart failure: Insights from the ATTEND study.Int J Clin Pract. 69(8):820-8. doi:10.1111/ijcp.12603Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012MedlinePlus.Natriuretic peptide tests (BNP, NT-proBNP).Inamdar AA, Inamdar AC.Heart failure: Diagnosis, management and utilization.J Clin Med. 5(7):62. doi:10.3390/jcm5070062National Heart Lung and Blood Institute.COPD.Merck Manuals Professional Version.Heart Failure (HF). New York Heart Association (NYHA) classification of heart failure.Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ.Trends in heart failure incidence and survival in a community-based population.JAMA. 2004;292(3):344-50. doi:10.1001/jama.292.3.344American Heart Association.Causes of heart failure.
American Heart Association.Warning signs of heart failure.
American Heart Association.Common tests for heart failure.
Minami Y, Kajimoto K, Sato N, et al.Third heart sound in hospitalised patients with acute heart failure: Insights from the ATTEND study.Int J Clin Pract. 69(8):820-8. doi:10.1111/ijcp.12603
Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012
MedlinePlus.Natriuretic peptide tests (BNP, NT-proBNP).
Inamdar AA, Inamdar AC.Heart failure: Diagnosis, management and utilization.J Clin Med. 5(7):62. doi:10.3390/jcm5070062
National Heart Lung and Blood Institute.COPD.
Merck Manuals Professional Version.Heart Failure (HF). New York Heart Association (NYHA) classification of heart failure.
Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ.Trends in heart failure incidence and survival in a community-based population.JAMA. 2004;292(3):344-50. doi:10.1001/jama.292.3.344
American Heart Association.Causes of heart failure.
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