How do you diagnose heart failure?

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The diagnosis of heart failure requires an examination and a number of tests:


Doctors usually suspect heart failure on the basis of symptoms alone. The diagnosis is supported by the results of a physical examination, including a weak, often rapid pulse, reduced blood pressure, abnormal heart sounds and fluid accumulation in the lungs (both heard through a stethoscope), an enlarged heart, swollen neck veins, an enlarged liver, and swelling in the abdomen or legs. A chest x-ray can show an enlarged heart and fluid accumulation in the lungs.

Electrocardiography (EKG) is almost always performed to determine whether the heart rhythm is normal, whether the walls of the ventricles are thickened, and whether the person has had a heart attack.

Echocardiography (ECHO), is one of the best procedures for evaluating heart function, including the pumping ability of the heart and the functioning of heart valves. Echocardiography can show the following:

  • Whether the heart walls are thickened and relax normally
  • Whether the valves are functioning normally
  • Whether contractions are normal
  • Whether any area of the heart is contracting abnormally

Echocardiography may help determine whether heart failure is due to systolic or diastolic dysfunction by enabling doctors to estimate the thickness and stiffness of the heart walls and the ejection fraction. The ejection fraction, an important measure of heart function, is the percentage of blood pumped out by the heart with each beat. A normal left ventricle ejects about 60% of the blood in it. If the ejection fraction is low, systolic dysfunction is confirmed. If the ejection fraction is normal or high in a person who has symptoms of heart failure, diastolic dysfunction is likely.

Other procedures, such as radionuclide, magnetic resonance, or computed tomography imaging and cardiac catheterization with angiography may be done to identify the cause of heart failure. Rarely, a biopsy of heart muscle is needed, usually when doctors suspect infiltration of the heart (as occurs in amyloidosis) or myocarditis due to a bacterial, viral, or other infection.

Hope this helps,

Dr T,

(From: The Merck Manuals, Heart failure, by J. Malcolm O. Arnold, MD)

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