Diagnosis of Congestive Heart Failure

Diagnostic Testing for Congestive Heart Failure

Often, the first diagnostic test performed is an X-ray of the chest which may show fluid in the lungs, enlargement of the heart (cardiomegaly) and other findings which suggest congestive heart failure. An EKG (electrocardiogram) may show evidence of an arrhythmia (abnormal heart beat), myocardial infarction (heart attack), electrical conduction defects, or hypertrophy (enlargement) of the left ventricle.

Once the diagnosis of congestive heart failure (CHF) has been established, a variety of diagnostic studies may be performed to evaluate left ventricular dysfunction in order to differentiate between systolic and diastolic dysfunction. The most commonly performed test for left ventricular dysfunction is echocardiography (a special ultrasound study of the heart). Other diagnostic tests that may be performed in select patients with CHF include:

• Nuclear ventriculography - A special imaging modality that uses radioactive tracers to view the chambers of the heart and the blood vessels
• Magnetic Resonance Imaging (MRI)
• Contrast angiography
• Stress testing to detect myocardial ischemia (reduced blood flow to the heart)
• Cardiac catheterization or angiogram to detect "blocked" coronary arteries

Laboratory testing for congestive heart failure may include:

• Complete blood count (to assess for anemia)
• Kidney function tests (blood urea nitrogen and creatinine)
• Electrolytes (especially sodium and potassium)
• Thyroid function
• Iron level studies
• Plasma B-type natriuretic peptide (BNP) - Measuring levels of this peptide (BNP) can help doctors differentiate between shortness of breath that is caused by CHF as opposed to shortness of breath that is due to pulmonary (lung) conditions