Heart failure diagnosis

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)
• Medications
• Personal medical history
• Symptoms

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 (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.

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).