How to diagnose heart failure

If you have symptoms of heart failure, your GP should offer you some checks and a blood test to see how well your heart is working.

If your blood test shows you might have heart failure, your GP should refer you to a specialist heart failure team and you may be offered further tests.

Tests for heart failure

Tests you may have to diagnose heart failure include:

  • 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
  • an echocardiogram – a type of ultrasound scan where sound waves are used to examine your heart
  • 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
  • a chest X-ray – to check whether your heart’s bigger than it should be, whether there’s fluid in your lungs (a sign of heart failure), or whether a lung condition could be causing your symptoms

You can read more about tests for heart conditions on the British Heart Foundation website.

Stages of heart failure

When you’re diagnosed with heart failure, your doctor will usually be able to tell you what stage it is.

The stage describes how severe your heart failure is.

It’s usually given as a class from 1 to 4, with 1 being the least severe and 4 being the most severe:

  • class 1 – you don’t have any symptoms during normal physical activity
  • class 2 – you’re comfortable at rest, but normal physical activity triggers symptoms
  • class 3 – you’re comfortable at rest, but minor physical activity triggers symptoms
  • class 4 – you’re unable to carry out any physical activity without discomfort and may have symptoms even when resting

Knowing the stage of your heart failure will help your doctors decide which treatments they think are best for you.

Page last reviewed: 26 October 2018
Next review due: 26 October 2021

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The following are key points to remember from this consensus statement on the diagnosis of heart failure with preserved ejection fraction (HFpEF):

  1. Although widely prevalent, diagnosis of HFpEF remains challenging. A prior consensus statement on diagnosis of HFpEF relied solely on echocardiographic data and natriuretic peptide levels, both of which have a low sensitivity. Accordingly, a revised algorithm has been proposed by the European Society of Cardiology (ESC), which endorses a novel, stepwise diagnostic approach.
  2. The proposed Heart Failure Association algorithm (HFA–PEFF) consists of: Pretest Assessment (P), Diagnostic workup with echocardiogram and natriuretic peptide score (E), Advanced workup with functional testing in case of uncertainty (F), and Final etiological workup (F).
  3. Pretest assessment should be performed in any patient who presents with symptoms and/or signs compatible with HF. This includes a detailed clinical evaluation, electrocardiogram, laboratory tests, and echocardiogram.
  4. Echocardiogram is indicated in all patients with HF symptoms. Preserved EF is defined as an EF >50%. HFpEF is suggested by normal EF, nondilated left ventricle with concentric remodeling, or left ventricular hypertrophy and left atrial enlargement.
  5. Step 2 includes a combination of detailed echocardiographic measurements and natriuretic peptide levels. To account for impact of modifiers such as age, etc., use of major and minor diagnostic criteria are recommended. Recommended echocardiographic criteria consist of functional markers (septal and lateral annular peak early diastolic velocities, tricuspid regurgitation velocity) and morphological markers (left atrial size and left ventricular mass index). Natriuretic peptide cut-offs have been specified based on underlying cardiac rhythm (sinus vs. atrial fibrillation).
  6. For each major criterion met, 2 points are awarded, and 1 point is awarded for a minor criterion. A score of ≥5 based on echocardiographic and natriuretic peptide levels is diagnostic of HFpEF. A score of ≤1 makes a diagnosis of HFpEF very unlikely.
  7. For a score of 2-4 points, additional workup in the form of diastolic stress echocardiography is recommended. There is no consensus on which exercise protocol should be used. If criteria for diastolic dysfunction during an exercise echocardiogram through E/e’ ratio and tricuspid regurgitant velocity are not met, invasive hemodynamic assessment through a right heart catheterization at rest or at exercise is the next step. A rest pulmonary capillary wedge pressure (PCWP) ≥15 mm Hg or exercise PCWP ≥25 mm Hg is diagnostic of HFpEF.
  8. The final step consists of establishing HFpEF etiology. This includes assessment of blood pressure control, chronotropic competence, arrhythmias, and ischemia. Cardiac magnetic resonance imaging should be considered where specific etiology such as amyloidosis or hypertrophic cardiomyopathy are suspected.

Keywords: Amyloidosis, Arrhythmias, Cardiac, Atrial Fibrillation, Biomarkers, Blood Pressure, Cardiac Catheterization, Cardiomyopathy, Hypertrophic, Diagnostic Imaging, Diastole, Echocardiography, Echocardiography, Stress, Electrocardiography, Heart Failure, Hypertrophy, Left Ventricular, Magnetic Resonance Imaging, Natriuretic Peptides, Pulmonary Wedge Pressure, Stroke Volume, Tricuspid Valve Insufficiency

Articles On Heart Failure Diagnosis

  • How Is Heart Failure Diagnosed?
  • BNP Blood Test
  • Echocardiogram

To check if you have heart failure, your doctor will ask you about your symptoms and may order some tests, as well. Once they figure out what’s going on, the two of you will work together to get the right treatment.

Physical Exam for Heart Failure

First, your doctor will want to know if you:

  • Have other conditions such as diabetes, kidney disease, angina, high blood pressure, or other heart problems
  • Smoke
  • Drink alcohol, and how much
  • Take medications, and which ones

Your doctor will also do a physical exam. They’ll look for signs of heart failure as well as other illnesses that may have weakened your heart.

During your visit, your doctor will:

  • Listen to your heart
  • Take your heart rate
  • Check your blood pressure

They’ll also look at your appearance while you sit, do mild activity, and lie flat. People with mild or moderate heart failure may appear comfortable at rest, but when active, they often become short of breath. Those with heart failure may be uncomfortable if they lie flat for a few minutes.

Your doctor may check for fluid in your lungs with a stethoscope. People with heart failure may also have neck veins that are larger than normal, swelling of the legs or abdomen, or an enlarged liver.

Tests for Heart Failure

The doctor may suggest you get some tests to find the cause of your heart failure and see how severe it is.

Blood tests. They look at your kidney and thyroid gland health and measure your cholesterol levels. They also check if you have anemia, which happens when you don’t have enough healthy red blood cells.

B-type natriuretic peptide (BNP) blood test. Brain natriuretic peptide is a substance your body makes. Your heart releases it when heart failure develops. It is turned into N-terminal pro-brain natriuretic peptide (NT-proBNP). Levels of both can be higher in people with heart failure. These tests can be used to help figure out if a patient’s shortness of breath is caused by heart failure.

Chest X-ray. This shows the size of your heart. It also lets your doctor know if there’s a buildup of fluid around your heart and lungs.

Echocardiogram. This test, often called an “echo,” shows your heart’s movement. During this exam, your doctor places a wand on the surface of your chest. It sends ultrasound waves that show pictures of your heart’s valves and chambers. Those images let your doctor look at how well your ticker is pumping.

Your doctor may combine an echocardiogram with tests called Doppler ultrasound and color Doppler to check blood flow across your heart’s valves.

Ejection fraction (EF). It’s a measure of how much blood is pumped out of your heart each time it beats. A normal amount is between 55% and 75%, which means that over half of the blood volume is pumped out of the heart with each beat. Heart failure may happen because of a low EF.

Electrocardiogram (EKG). This records the electrical impulses traveling through your heart. During the test, your doctor puts small, flat, sticky patches called electrodes on your chest. They’re attached to a monitor that charts your heart’s electrical activity on graph paper. This test can tell your heart rhythm and give a general roadmap of your heart’s ability to pump blood.

Cardiac catheterization. This measures whether you have clogged heart arteries (called coronary artery disease). Your doctor may also call it coronary angiogram.

Cardiac MRI. This less-commonly used test helps your doctor figure out if you have problems with your heart muscle or the tissues that surround the heart.

CT coronary angiogram. It uses an X-ray and a contrast dye to see if you have coronary artery disease. Your doctor can view images in 3-D, which lets them see blockages in your arteries.

Myocardial biopsy. In this test, your doctor puts a small, flexible biopsy catheterВ into a vein in your neck or groin, and takes a small piece of your heart muscle. This test can diagnose certain types of heart muscle diseases that cause heart failure.

Stress test. Your heart gets “stressed” when you walk on a treadmill or take medications that increase its pumping. It helps your doctor find clogged heart arteries.

Show Sources

American Heart Association: “Common Tests for Heart Failure,” “Symptoms & Diagnosis of Heart Failure,” “Heart Failure.”

UpToDate: “Natriuretic peptide measurement in heart failure.”

Mayo Clinic: “Coronary angiogram: Overview.”

Cleveland Clinic: “Myocardial Biopsy.”

Heart Failure Society of America: “Learn More About Heart Failure.”

National Heart Lung and Blood Institute: “How Is Heart Failure Diagnosed?”

How to diagnose heart failure

Congestive heart failure happens when the heart muscles are pumping inefficiently due to fluid buildup around the heart. It’s best to get tested, especially if you are at high risk for the condition or have a family history of it. Coronary artery disease, high blood pressure, and a history of heart attacks are all signs that you may be at a higher risk for congestive heart failure. If you smoke, drink excessively, have diabetes, or kidney disease, you are also at a higher risk.

Heart failure doesn’t necessarily happen suddenly. It can be chronic, in which case you won’t necessarily know what’s going on unless you monitor yourself for signs and symptoms. These include:

  • Shortness of breath, even when resting
  • Reduced ability to exercise, perform regular chores, and move around
  • A rapid or irregular heartbeat
  • Persistent coughing or wheezing
  • Weight gain as a result from fluid retention
  • Chest pain

If you notice these symptoms, see a doctor immediately. You will need to get examined and tested for the possible underlying cause of your symptoms. So, how is congestive heart failure diagnosed? Here are a few examples of the tests a doctor can perform to diagnose you. You will not need all of them to get diagnosed. Your doctor will determine which combination of tests are best to get accurate results.

Blood Test

Through a blood sample, your doctor can identify certain biomarkers that point to heart failure. A blood test can reveal your cholesterol levels and determine if you have anemia. A blood test can also determine if you have good kidney and thyroid function.

Chest X-Rays

X-rays are another common testing procedure for congestive heart failure. An X-ray can reveal an enlarged heart and congestion in the lungs.


An electrocardiogram (also called EKG) is a test that involves the placement of electrodes on your chest to record heart rhythm, heartbeat frequency, and electrical conduction. An electrocardiogram can reveal a thickening of the left ventricle or an abnormal heartbeat rhythm – which are signs of congestive heart failure.


Also referred to as an echo, this test utilizes ultrasound technology to examine the heart structures and movement. It can reveal a thickening of the heart muscles and whether your heart is pumping efficiently.

Cardiac Computerized Tomography Scan

Also called a CT scan, this exam involves you getting an imaging test done inside a machine that’s shaped like a doughnut. Using X-ray technology, the machine takes pictures of your heart and chest. It can reveal an enlarged heart, weakened muscles, and problems with heart function.

Exercise Stress Test

An exercise stress test involves being hooked up to a heart monitor and possibly a treadmill to simulate exercise. It shows the doctor how your heart responds to exercise and whether the response is normal. This test can also reveal if you have reduced blood supply in the heart.

Carrus Health Advanced Radiology Department

At Carrus Health, we provide the imaging tests you need for a clinical diagnosis of congestive heart failure. We currently offer CT Scans, X-rays, and ultrasounds to diagnose your condition. Our radiology facility in Sherman, Texas is spacious, clean, and comfortable.

To schedule an appointment, please call Carrus Health at (903) 870-2600. Our friendly staff looks forward to assisting you.

How to diagnose heart failure

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Advanced Heart Failure Tests and Diagnosis

If you have heart failure, your doctor will want to know how severe your condition is — and what the root cause may be — such as a heart attack, long-standing high blood pressure, a virus, etc. How you respond to therapy is important to know, too. Every patient is different — and your condition can change over time — so regular follow-ups will be part of your care plan. This lets us adjust treatment as needed to be most effective for you.

Your doctor will also consider how your heart condition affects the rest of your body. For example, it’s important to know if your kidneys, or muscles in your arms and legs, are getting enough blood.

Other conditions like obesity or untreated high blood pressure place extra strain on your heart. Addressing these conditions will help improve or stabilize your heart so you can enjoy the best possible quality of life.

Heart Failure Tests

Hear failure is a complex condition and there are many factors for your doctor to consider. Talk to your doctor about your symptoms, and your past medical history. Your doctor will examine to you to listen to your heart and lungs, check your skin for signs of extra fluid and order other tests as needed.

Blood Tests

Blood tests tell your doctor about your kidneys, liver, thyroid, blood cell count, electrolytes and blood cholesterol. Your doctor will review past blood test results to see if you need more tests.

Electrocardiogram (ECG or EKG)

An EKG reads your heart rhythm through electrode patches applied your legs, arms and chest. This can help your doctor diagnose different causes of heart failure.


Echocardiograms use ultrasound to show how your heart valves and chambers are working. This test tells your doctor how much blood your heart pumps out (ejects) and how well your heart is pumping. You may hear this measurement referred to as your ejection fraction or “EF.”

Stress Tests

The Emory Advanced Heart Failure Therapy Center uses several kinds of stress tests.

  • Exercise stress test (also called treadmill test, regular exercise test or exercise cardiac stress test)
  • Exercise perfusion stress test (exercise thallium stress test)
  • Stress nuclear perfusion test (nuclear stress test)
  • Stress echocardiography (dobutamine stress echocardiogram)
  • Cardiopulmonary exercise test

Sleep Study

Sleep apnea, a common condition in which a person may experience pauses in breathing five to 30 times per hour or more during sleep, prevents restful sleep and is associated with high blood pressure, arrhythmia, stroke and heart failure.

During a sleep study, a sleep technologist will monitor your body functions in a sleep lab. They can measure brain waves, eye movement, respiration, oxygen level in the blood, snoring or other sounds.

Coronary Angiogram

You doctor may use coronary angiogram to:

  • Look for narrowed or blocked blood vessels in your heart
  • Check your heart’s size
  • See how well your heart pumps
  • See how well your heart valves work

To do the test, your doctor inserts a catheter (small tube) with a tiny camera into a blood vessel in your arm or leg, then feeds it through that vessel to your heart. X-ray pictures (angiograms) are recorded using digital imaging and/or 35mm film.

Heart PET Scan

Where other imaging tests show structure, positron emission tomography (PET) scans show organ and tissue chemical function. PET helps detect blocked blood vessels in your heart by showing blood flow and metabolism with superior accuracy. The results help your doctor understand the extent of your heart disease and see if blockages need treatment. PET imaging can also help your doctor decide if your heart muscle is weakened or damaged beyond repair.

Cardiac Magnetic Resonance Imaging (Cardiac MRI)

MRI uses a large magnet and radiofrequency waves to produce high quality images of your heart and blood vessels. MRIs give your doctor live, moving images of your beating heart from different angles. The images help your doctor detect congenital (present at birth) heart disease, coronary artery disease and aortic disease.

CT Coronary Angiography (CTA)

CT coronary angiography (CTA) is a noninvasive test that uses X-ray with iodine-based contrast agents (dyes). The Emory Cardiac Imaging Center uses a state-of-the-art, multi-detector CT system. It creates high-resolution images of your heart and great vessels to help your doctor find plaques (build-up) in your coronary arteries.

Chest X-ray

Chest X-rays help your doctor find problems in the heart, lungs, bones or blood vessels. Your doctor may order chest X-ray for:

  • Bad or persistent (ongoing) cough
  • Chest pain
  • Chest injury
  • Coughing up blood
  • Fever
  • Shortness of breath
  • Falls

Did You Know?

Emory offers state-of-the-art Cardiac Imaging where our team of cardiac imaging specialists from radiology and cardiology work together to provide patients with the most accurate and appropriate diagnostic medical imaging services available.

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To make an appointment, please call 404-778-7777.