Although heart failure is a common condition, the diagnosis is often missed. A critical part of diagnosis is identifying the exact cause of heart failure. At the Penn Heart Failure Program, our specialists get you an accurate diagnosis so you can quickly receive the right heart failure treatment.
Heart Failure Diagnosis: The Penn Medicine Difference
Accurate heart failure diagnosis requires a careful review of your history and symptoms, as well as advanced, accurate testing. When you come to Penn, you will find:
- Expert team: Our physicians, nurses and cardiac imaging technicians are specially trained in heart failure and only treat patients with this condition. Their experience helps them see details others may miss. Meet our heart failure team.
- Advanced testing capabilities: We have the tools and expertise to evaluate your heart’s structure and function in fine detail, including options not available at other centers. Our program has access to advanced technologies like positron emission tomography (PET), pyrophosphate scans and gene testing. These tools help us diagnose even subtle cases of heart failure and detect problems earlier.
- Comprehensive diagnosis: The Penn Heart Failure Program takes a very active, comprehensive approach to testing. We explore all possible causes of heart failure and base our final diagnosis on the latest scientific information. This evidence-based approach has helped thousands of patients with heart failure.
- A vast network of specialists: Penn is an academic medical center with vast resources. If diagnostic tests for heart failure reveal other medical issues, we can quickly consult with any type of physician or surgeon you may need. The heart failure team coordinates your multispecialty care to make it seamless for you.
- Care close to home: Our heart failure specialists care for patients in Philadelphia and at satellite locations throughout the Philadelphia suburbs and Southern New Jersey. You don’t need to go far for an accurate diagnosis. Our heart failure specialists also participate in a shared care model for patients who live far away. When appropriate, your local cardiologist can do some testing and follow-up care.
- Comprehensive genetic counseling and support: Genetic causes of heart failure can impact your treatment plan. Inherited heart failure can also affect other family members. We work with dedicated genetic counselors who can determine what genetic tests you and your relatives may need.
How Do You Diagnose Heart Failure?
If your doctor suspects you have heart failure, you will need a series of tests to help determine the exact cause. Those tests include:
History and Physical Exam
During a physical exam, a physician will listen to your heart and lungs, and review your blood pressure and weight. The clinical team will also ask you about your:
- Family medical history
- Lifestyle (for example, whether you smoke)
- Personal medical history
Part of the heart failure evaluation is a series of blood tests to check for problems with your heart or other organs. These tests measure:
- Sodium and potassium (electrolytes)
- Albumin (which helps determine how well your liver is working)
- Creatinine (which helps measure how well your kidneys are working)
- Other biomarkers that indicate heart failure
Echocardiography and Ejection Fraction
Echocardiography (echo) uses sound waves to create images of your heart. Echo can show how thick the heart muscle has become and how well the heart is pumping.
Echo is also used to measure ejection fraction (EF), the percentage of blood the left ventricle of the heart pumps out with every heartbeat. It is a sign of how well your heart is pumping out blood.
The normal, healthy range for EF measurement is 50 to 70 percent. EF higher or lower than normal can indicate an issue with your heart.
Cardiovascular Imaging Tests
After considering your history, symptoms, blood test and echo results, the heart failure team may suggest advanced diagnostic and cardiovascular imaging services, including:
- Left heart catheterization: Your doctor inserts a small tube into an artery in your leg or arm and passes to your heart. A special dye that can reveal blocked arteries is injected into the tube. X-rays of your heart show any blockages.
- Right heart catheterization: Your doctor inserts a small tube into a vein in your leg, arm or neck and passes it to your heart. The catheter measures pressure in different chambers of your heart and pulmonary artery. These pressures show how much fluid has accumulated. That information can be used to calculate how much blood your heart is pumping with every beat.
- Chest X-rays and MRI: These tests take pictures of structures inside your chest. They can show whether your heart is enlarged or damaged, or if you have extra fluid in your lungs. MRI can also reveal causes of heart failure.
- Remote monitoring devices: We use implantable and wearable devices to monitor your heart and detect problems before you have symptoms. The devices can measure the heart’s rate, rhythm, electrical impulses and other bodily functions while you go about your day. Our team uses devices that are not available at many other centers in the region.
- Electrocardiogram (EKG or ECG): This test uses small sensors to measure heart rate, rhythm and electrical impulses. It can show whether you’ve had a heart attack or have an abnormal heart rhythm. It can also reveal that the heart muscle wall may be abnormally thick.
- Exercise stress test: You walk on a treadmill while hooked up to equipment that monitors your blood pressure and heart rate, rhythm and electrical activity.
- Multiple-gated acquisition scan (MUGA scan): MUGA uses a radioactive liquid injected into your bloodstream to show how well your heart is working and whether there is any heart damage.
- Positron emission tomography (PET) scan: PET scans provide images of your tissues and organs and detect inflammation. This high-resolution technique can help us detect problems before they show up on more basic imaging tests.
- Pyrophosphate scan: This advanced nuclear test can detect whether a patient has cardiac amyloidosis (abnormal protein deposits in the heart).