An initial evaluation for congestive heart failure (CHF) may include:
- A medical history, including an evaluation of risk factors such as age, family history, coronary artery disease (CAD), diabetes, and high blood pressure
- A physical examination—a healthcare practitioner may listen to the heart and lungs with a stethoscope to detect fluid buildup and look for swelling of the hands, feet, and legs.
Additionally, a combination of laboratory and non-laboratory tests may be used to assess CHF.
Laboratory tests that may be ordered include:
- B-type natriuretic peptide (BNP) or N-terminal pro-BNP—measure the concentration of a hormone produced by the left ventricle (the main pumping chamber of the heart) to help diagnose and grade the severity of heart failure
- Metabolic panel—to check for electrolyte imbalance, kidney failure (since symptoms of kidney disease are similar to those of CHF) and liver disease
- Complete blood count (CBC)—to check for anemia, which can cause similar symptoms to CHF as well as contribute to CHF
- Thyroid tests—these tests check the level of thyroid hormone in the blood; both hyperthyroidism (too much thyroid hormone) and hypothyroidism (too little thyroid hormone) can cause heart failure.
There are two relatively new tests that may be used for people diagnosed with heart failure to help predict the course of the disease (prognosis). Galectin-3 and ST2 are tests that measure the levels of these proteins in blood. Elevated levels of these biomarkers may be used to indicate if a person with heart failure is at increased risk for complications and needs more aggressive treatment.
Non-laboratory tests may include:
- An electrocardiogram (ECG or EKG)—a test that looks at the heart's electrical activity and rhythm
- Chest X-ray—may show whether the heart is enlarged or if fluid is present in the lungs
Based on the findings of these tests, other procedures may be necessary, including:
- An exercise stress test
- Nuclear heart scan—a radioactive compound is injected into the blood to evaluate blood flow and show images of narrowed blood vessels around the heart.
- Echocardiography—ultrasound imaging of the heart
- Cardiac catheterization—in this procedure, a thin flexible tube is inserted into an artery in the leg and threaded up to the heart; it allows the physician to evaluate pressure and blood flow within the chambers of the heart.
- Coronary angiography—this test is performed during cardiac catheterization; X-rays of the coronary arteries, which supply blood to the heart, are taken after injecting a radiopaque dye to help diagnose coronary artery disease.
For more information on these, visit the National Heart, Lung and Blood Institute: How is Heart Failure Diagnosed?