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Diagnosis of Congestive Heart Failure

 The diagnosis of congestive heart failure is most often based on a physical examination and the patient’s medical history. A thorough history may disclose some of the symptoms described above. Other factors like hypertension, diabetes, coronary heart disease and drug or alcohol abuse may also provide some clues to the examining physician.

The physical examination focuses on detecting excess fluid in the body, be it the swelling in the legs or the sounds of breathing. The pulse rate, blood pressure and heart sounds also provide clues.

Tests for congestive heart failure include the electrocardiogram (ECG) and chest X-rays which help detect previous heart attacks, arrhythmia and fluid buildup around the lungs. The echocardiogram is the most useful diagnostic tool for this condition. In an echocardiogram, ultrasound is used to form an image of the heart muscle, the valves and the blood flow patterns. The test may also suggest possible causes for the weakened heart muscles. Ideally, all patients should undergo this test early on in their assessment.

Nuclear medicine studies can provide an assessment of the overall pumping capacity of the heart as well as the supply of oxygenated blood to the heart muscles. Cardiac catheterization allows the coronary arteries to be examined visually. This is accomplished by injecting the coronary arteries with a dye which shows up as a contrast in X-ray studies. Pressures in and around the heart can also be measured and the performance of the heart assessed. A biopsy of the heart tissue may also be recommended to diagnose specific diseases.

A blood test known as a BNP or B type natriuretic peptide level is another useful diagnostic aid. Typically, the level is elevated in cases of congestive heart failure and can be used to gauge a patient’s response to treatment.