Tests for heart failure

  • Blood tests to check whether there's anything in your blood that might indicate heart failure or another illness
  • An electrocardiogram (ECG) this records the electrical activity of your heart to check for problems. The electrocardiogram always presents with anomalies. It can indicate rhythm disorders, such as atrial fibrillation, ventricular arrhythmia, blockage of the left branch, etc.
  • An echocardiogram is a type of ultrasound scan where sound waves are used to examine your heart. A two-dimensional echocardiography is a very useful examination in order to definitely determine the diagnosis of cardiomyopathy and heart failure. This examination also serves to differentiate from other diagnoses such as restrictive cardiomyopathy, valve or pericardium diseases etc. Angiograms are used only if necessary. 
  • Breathing tests you may be asked to blow into a tube to check whether a lung problem is contributing to your breathlessness; common tests include spirometry and a peak flow test.
  • Chest X-ray to check whether your heart is bigger than it should be, whether there is fluid in your lungs (a sign of heart failure), or whether a lung condition could be causing your symptoms. Radiological examinations of the chest indicate heart enlargement as well as swelling of the blood vessels in the lungs, which suggests that there is an increase of pulmonary venous pressure. 
  • The diagnosis is based on the information collected from the patient history; organic symptoms such as dyspnea, pulmonary stasis, tachycardia, a galloping rhythm, coughing with hemoptoic sputum etc., are all symptoms which attest to problems of the left ventricle. 
  • Cyanosis, liver enlargement, edemas, transudates in serous cavities, swollen jugulars, an increase of venous pressure, etc., are all symptoms which attest to problems of the right ventricle.   

Differential diagnosis process

Physicians run differential diagnosis against the following conditions:

  1. Cardiac diseases, which lead to insufficiency such as heart ailments, hypertensive disease, ischemic heart diseases, etc. 
  2. Bronchopulmonary diseases accompanied by dyspnea, such as bronchial asthma, chronic obstructive bronchitis, pulmonary emphysema, lung cancer. 
  3. Renal diseases.
  4. Hepatic cirrhosis rendered decompensated by ascites and edema. 

Diagnosis of left ventricular heart failure

During an examination of the heart, the physician observes that the left ventricle has been displaced to the bottom left, the heart sounds are muted, there is a fast and a galloping rhythm and systolic noise can be heard at the apex of the heart as a consequence of the functional insufficiency of the mitral valve. At the base of both lungs one can hear faint stasis rales; at times a pleural liquid may appear, which pertains to the transudate type. Patients do not suffer from edemas and the venous pressure is normal. 

Radiological examinations indicate an enlarged left ventricle, hilar and basal lung stasis; at times hydrothorax (liquid accumulation), more often occurring on the right.

The electrocardiogram exhibits signs of an overload of the left ventricle, which is often accompanied by a blockage of the left branch.

Diagnosis of right ventricle heart failure

Upon conducting a heart examination, tachycardia is evident, the heart sounds are muted, there are galloping sounds and systolic noises in the vicinity of the xiphoid process (the cartilaginous section at the lower end of the sternum, which is not attached to any ribs, and gradually ossifies during adult life). These indicate a functional insufficiency of the tricuspid valve. In the epigastric region, one can observe the pulsations of the enlarged right ventricle. As a consequence of venous stasis, the jugulars are swollen, the venous pressure is high, and the speed of blood circulation is slow. 

Radiological examinations attest to the following: The right ventricle, and at times the right atrium is enlarged. The infundibulum (a conical pouch formed from the upper and left angle of the right ventricle in the chordate heart) appears more swollen. There are other examinations that can be performed in order to visualize the enlarged heart, but the radiological examination is the clearest, most effective method that can be used to set a diagnosis. 

The electrocardiogram exhibits hypertrophy of the right ventricle, which oftentimes can be accompanied by a blockage of the right branch. 

Diagnosis of biventricular heart failure

Biventricular heart failure occurs as a consequence of the combination of the failure of the left and right ventricles. There are no particular symptoms, but more often than not the symptoms of the failure of the right ventricle (with peripheral venous stasis) are more predominantly visible.  Usually, when the failure of the right ventricle emerges, the patient feels better, because symptoms and conditions such as cardiac asthma and acute pulmonary edema disappear. 

If you have symptoms of heart failure, your GP will ask you to describe them in detail. They will also carry out a physical examination.

If they think you could have heart failure, they may refer you to a hospital specialist for further tests.



Content supplied by the NHS Website

Medically Reviewed by a doctor on 5 Aug 2016