Understanding Heart Failure -- Diagnosis and Treatment

How Do I Know If I Have Heart Failure?

Doctors diagnose heart failure by taking a medical history and conducting a physical exam and tests. During the medical history your doctor will want to know if:

• You have any other health problems such as diabetes, kidney disease, angina (chest pain), high blood pressure, or other heart problems.
• You smoke.
• You drink alcohol and if so, how much?
• You are taking medications.
• Any of the symptoms listed in section above for heart failure.

During the physical, the doctor will check your blood pressure, use a stethoscope to hear sounds associated with heart failure in the heart and lungs, and look for swollen neck veins, an enlarged liver and swollen feet.

Further testing to confirm the diagnosis may include:

Blood tests — to check for anemia, thyroid problems, and high cholesterol. These conditions can be related to heart failure. There is also a newer test for B-type natriuretic peptide (BNP), which can indicate active heart failure.

Urine tests — to look for signs of kidney problems or diabetes (which can cause heart disease.)
Electrocardiogram (ECG or EKG) — to assess the heart rate and rhythm. It can often detect heart disease, heart attack, an enlarged heart or abnormal heart rhythms that may cause heart failure.

Chest X-ray — to see if the heart is enlarged and if the lungs are congested with fluid.

Echocardiography — an ultrasound test to evaluate heart muscle function, how well the heart is pumping and detect problems with the heart valves that may cause heart failure. Ejection fraction (EF) also can be measured. EF is a measure of how much blood is pumped out of the heart with each beat, and how much blood pumps through the heart with each beat. A normal EF is generally greater than 50%, which means that over half of the blood volume is pumped out of the heart with each beat.

Radionuclide ventriculography — a sophisticated imaging study that specifically shows the function of the ventricles (the heart's large pumping chambers) during heart contractions. This test can also measure EF.
Exercise Stress Test (an ECG performed while exercising — either walking on a treadmill, riding a stationary bike, or using medications to simulate exercise) — to check for any heart function problems brought on by exercise, which indicates of heart disease.

In addition, your doctor may perform a variety of more invasive tests such as cardiac catheterization to directly visualize the heart's chambers and inject dye to view the heart's arteries. This test can determine if coronary artery disease is present and can measure EF.

What Are the Treatments?

Treatment of CHF focuses on slowing or reversing its progression. The earlier you are diagnosed and treatment is initiated, the better the outcome.

First, your doctor will recommend a series of lifestyle changes. You may be asked to reach and maintain a healthy weight, increase your activity level (as recommended by your doctor), restrict salt intake, restrict fluid intake, and avoid alcohol. If you smoke or chew tobacco, you'll be advised to stop. You will need to work with your doctor to find the right balance of rest and activity - mobility is important to keep blood circulating. You will also need to weigh yourself daily and record your weight to detect fluid retention.