Heart Failure

If you have signs and symptoms of heart failure, your doctor may order the following tests:

• EKG or ECG (electrocardiogram) This test is used to measure the rate and regularity of your heartbeat. It may show if you have had a heart attack or have thickening of the walls of the pumping chambers of the heart (ventricles).
• Chest x-ray A chest x-ray takes a picture of your heart and lungs. It can show if your heart is enlarged, if you have fluid in your lungs, or if you have lung disease.
• BNP blood test This new test checks the level of a hormone called BNP (B-type natriuretic peptide) that rises in heart failure.

If your doctor suspects heart failure after the history, physical exam, and initial tests (such as tests of kidney function), he/she may refer you to a cardiologist. A cardiologist is a doctor who specializes in the diagnosis and treatment of heart disease. The cardiologist will do a physical exam and order additional tests.

An echocardiogram is the most useful test for diagnosing heart failure. This test uses sound waves to create a picture of the heart. It shows how well the heart is filling with blood and pumping it to the rest of the body. It can also show the areas of your heart muscle that are not contracting normally. Your doctor uses this test to determine the areas of your heart that are damaged and causing it to not work properly. This is very important because more than one area of the heart can be damaged and contribute to heart failure.

The cardiologist may order any of the following tests. These tests can help identify the cause of your heart failure:

• Holter monitor (ambulatory electrocardiography, EKG/ECG) For this test, a small box called a Holter monitor is attached to patches (electrodes) that are placed on your chest. The box may be carried in a pouch around your neck or attached to your belt. The Holter monitor is usually worn for 24 hours and provides a continuous recording of heart rhythm during normal activity.
• Cardiac blood pool scan (radionuclide ventriculography or nuclear scan) This test uses a radioactive imaging agent that is injected into a vein to outline chambers of the heart and blood vessels leading to the heart. This will show how well the heart is pumping blood to the rest of the body.
• Cardiac catheterization A thin flexible tube is passed through an artery at the top of the leg (groin) or in the arm to reach the coronary arteries. This allows your doctor to study the inside of your arteries to see if there is any blockage. Your doctor can check the pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x-ray.
• Coronary angiography This test is usually performed along with cardiac catheterization. A dye that can be seen by x-ray is injected into the coronary arteries. Your doctor can see the flow of blood to the heart muscle. Dye can also be injected into the chambers of the heart to evaluate the pumping function of your heart.
• Exercise stress test EKG and blood pressure readings are taken before, during, and after exercise to see how your heart responds to exercise. The first EKG and blood pressure reading are done to get a baseline. Readings are then taken while you walk on an exercise treadmill or pedal a stationary bicycle. The test continues until you reach a heart rate set by your doctor.
• Thyroid functions tests These are common procedures done to find out how well the thyroid is functioning. They include blood tests, various imaging procedures, and stimulating thyroid function. These tests are very important because both an overactive and an underactive thyroid can be the main or a contributing cause of heart failure.