How is a heart failure diagnosed?

Intermountain Healthcare
To diagnose and assess the degree of heart failure, your healthcare providers will do a thorough medical history as well as many of the other tests described below. These tests may also help determine the cause of your heart failure.
  • Medical history: This includes questions about your symptoms and habits, other conditions and treatments, and whether members of your family have had heart problems.
  • Blood tests: This may include a red blood cell (RBC) count, electrolytes, and tests that assess your kidney, liver and thyroid.
  • Urinalysis: Studying a sample of your urine can help detect any problems with your kidneys or bladder that may be contributing to your heart failure.
  • Chest x-ray: An x-ray image of your chest shows the size of your heart and can help determine if you have fluid buildup in your lungs.
  • Electrocardiogram (EKG or ECG): This test records the electrical activity of your heart.
  • Stress testing: This test shows how your heart responds to the stress. Exercise stress testing uses physical exertion to stress your heart. Certain medications may also be used.
  • Echocardiogram (echo): An echo uses sound waves to create an image of the structure and movement of your heart. This shows how well your heart is pumping, how well your heart valves are working, and how enlarged your heart is. Echos are often used to measure your ejection fraction (EF), which is the percent of blood pumped with each heartbeat.
  • Angiogram: An angiogram is performed in a cardiac catheterization lab. During the test a long, thin tube called a catheter is inserted through a blood vessel and guided into the heart. Dye is injected through the catheter and x-rays track the flow of blood to your heart muscle. This test can also diagnose coronary artery disease, which is a cause of heart failure.
Francis X. Downey, MD
Thoracic Surgery (Cardiothoracic Vascular)

Echocardiography is the most common way to detect heart failure. An echocardiogram is an ultrasound showing heart function.

Sometimes heart failure is detected during a cardiac stress test. Cardiac stress tests show whether the heart is getting enough blood flow and overall cardiac function.

Linda Martinez
Cardiac Rehabilitation

Heart failure is diagnosed using the history of the patient, a physical examination by a primary care provider (physician, physician assistant or nurse practitioner), blood tests, chest x-ray and/or echocardiogram. These tests may not be done all in the same day.  The healthcare provider may first await findings of certain tests before sending the patient for other tests.  The primary care provider may also refer the patient to a specialist such as a heart doctor (cardiologist).

Diagnosing heart failure begins with a routine exam and a review of your medical and family history to check for heart failure risk factors. The doctor will use a stethoscope to listen for fluid build up in the lungs and proper heart function. The doctor may also check the lower portions of your body and the veins in your neck for swelling. After the routine exam, the doctor may order additional diagnostic tests. Blood tests check for kidney and thyroid function. A chest X-ray is used to check for fluid build-up in the lungs and heart enlargement. Heart function is tested with an electrocardiogram to check the electrical activity of the heart. An echocardiogram evaluates heart function using sound waves to test if the heart is pumping properly, check heart valve problems, or look for signs of previous heart attacks. A stress test measures how the heart and blood vessels respond to physical activity through exercise or medication that simulates the effects of exercise. Coronary catheterization (angiogram) tests the strength of the heart valves and heart's primary pumping chamber.

Piedmont Heart Institute
Your doctor will diagnose heart failure based on your medical and family histories, a physical exam, and tests. Because the symptoms of heart failure also are common in other conditions, your doctor must:
  • Find out whether you have a disease or condition that can cause heart failure, such as coronary artery disease (CAD), high blood pressure, or diabetes
  • Rule out other causes of your symptoms
  • Find any damage to your heart and measure how well your heart pumps blood
  • Early diagnosis and treatment can help people with heart failure live longer, more active lives.
Medical and Family Histories
Your doctor will ask whether you or others in your family have or have had a disease or condition that can cause heart failure.
Your doctor also will ask about your symptoms. He or she will want to know which symptoms you've have, when they occur, how long you've had them, and how severe they are. The answers will help show whether and how much your symptoms limit your daily routine.
Physical Exam
During the physical exam, your doctor will:
  • Listen to your heart for sounds that aren't normal
  • Listen to your lungs for the sounds of extra fluid buildup
  • Look for swelling in your ankles, feet, legs, abdomen, and the veins in your neck
  • Diagnostic Tests
    No one test shows whether you have heart failure. If you have signs and symptoms of heart failure, your doctor may order an EKG (electrocardiogram), a chest x ray, and a BNP blood test as initial tests.
    This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.

Continue Learning about Heart Failure

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.