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Heart Failure

Heart Failure - Diagnosis

The diagnosis of heart failure is based on:

1) Symptoms: 

Symptoms can provide important clues to the presence of heart failure. Shortness of breath while engaging in activities and episodes of shortness of breath during sleep are classic symptoms of heart failure

2) Physical examination: 

The signs of heart failure can be detected in a physical examination. The doctor looks for distended or bloated neck veins, displacement of the heart pulse on the chest, and swelling in the legs & tummy. With the use of a stethoscope, the doctor can listen for crackles in the lungs which suggest fluid build-up. The doctor might press on the abdomen to check if the liver is enlarged. The skin of the fingers and toes may have a bluish tint and feel cool if not enough oxygen is reaching them.

3) Tests:

  • Blood tests: Allow doctors to check for increases in levels of certain molecules which could indicate heart failure. Also show how well liver and kidneys are working. 
  • Chest radiograph (X-ray): Chest radiographs can show if there is fluid in the lungs or if the heart is enlarged. Abnormalities of heart valves and other structures also may be seen.
  • Electrocardiogram (ECG; also called EKG): An electrocardiogram gives information on the heart rhythm and evidence of previous heart attack.
  • Echocardiography: An echocardiography shows if the heart wall or chambers are enlarged and if there are abnormalities of the heart valves. It  can be used to find out how much blood is being pumped out of the heart chambers.
  • Cardiac Magnetic Resonance Imaging (CMR): A cardiac MRI supplements the findings of an echocardiogram and is excellent for cardiac tissue characterisation. It is important to tell your doctor about any problems with your kidneys before going for the CMR.
  • Cardiac catheterisation: In patients with suspected coronary artery disease, cardiac catheterisation can be performed using small tubes which are pushed up the blood vessels to the heart arteries. The injection of a dye through these tubes allows the doctor to examine the heart arteries for blockages with the aid of X-rays. If suitable, these blockages can be fixed in the same setting. This test can also help confirm the severity of heart valve disease. 
  • Exercise stress test: This test is performed to indirectly look for coronary artery disease. Patients will be requested to exercise while attached to an ECG machine, to look for changes in the ECG tracing which suggest heart artery blockages. In patient who are not able to exercise, medications can be given to stress the heart, with similar effects to exercise. Stress tests can be coupled with echocardiography, MRI or nuclear scanners to improve its accuracy. 

During the diagnosis of heart failure, the doctor will usually be able to determine how serious the patient’s condition is.
Stage What it means
A: Cardiovascular disease
  • At risk for developing heart failure
  • No symptoms or signs of heart failure
B: Structural or functional heart disease
  • Structural or functional heart disease present
  • No symptoms or signs of heart failure
C: Overt heart failure
  • Structural or functional heart disease present
  • Has symptoms of heart failure
D: Advanced heart failure
  • Advanced structural heart disease
  • Severe symptoms even with maximum medical intervention


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