Heart Failure Diagnosis

  • Diagnosis

    Congestive heart failure is a condition in which the heart does not pump blood properly. Congestive heart failure occurs when the heart, due to a defect, injury, or disease, is not able to pump enough blood to meet the body's needs. When this happens, body tissues, which depend on the oxygen and nutrients in blood circulated from the heart, no longer receive enough nourishment. As a result, patients experience shortness of breath when climbing stairs and walking quickly, and tire easily. Because the heart's ability to pump blood is reduced, fluid other than blood builds up in the tissues that were being nourished by a constant flow of blood — this causes the tissues to retain fluid and to swell. Also, because the heart is weakened, it cannot prevent excess fluid from backing up in the lungs, which is why patients have difficulty breathing. The “congestive” in congestive heart failure refers to the buildup of fluid in tissues and the lungs.

    Heart failure can occur on the left or right side of the heart, and usually affects either the left or right ventricle Figure 01. Left ventricle failure is more common. When this happens, fluid backs up into the lungs, and, because the pumping action of the heart slows down, fluid builds up throughout the body. In right ventricle failure, blood backs up in the veins, which often leads to swelling in the ankles and legs. Because the functions of the different parts of the heart are interrelated, failure on the left side often results in failure on the right.

    Click to enlarge: The flow of blood through a healthy heart (animation and audio)

    Figure 01. The flow of blood through a healthy heart (animation and audio)

    Heart failure is a chronic disease that develops slowly. Noticeable symptoms may not appear for years, but as the heart gradually loses pumping capacity, it tries to adjust by enlarging, thickening, and beating more often. Blood vessels also begin to narrow, diverting blood away from less important tissues to the major organs of the body. These strategies on the part of the heart hide the problem, and patients may not be aware that they have congestive heart failure until the serious symptoms of chronic fatigue and shortness of breath appear.

    Nearly five million Americans live with congestive heart failure. Congestive heart failure is a growing health problem, and is the most common diagnosis for hospitalized patients aged 65 years and older. Each year 400,000 people learn they have the condition. While most common among older adults, people of any age, including children, can suffer from congestive heart failure. The disease affects men and women in equal numbers. However, prevalence is 25% higher in the African American population than among whites.

    A combination of medications and self-care techniques helps patients live longer and more comfortably.

    Treatment may include surgery to restore blood supply to the heart, or to replace damaged valves. Transplant surgery is considered only as a last resort.

    Damage to the heart muscle from a heart attack or infection prevents the heart from pumping blood efficiently Figure 02. If the heart muscle is damaged by heart diseases such as heart attack (myocardial infarction) or coronary artery disease, the risk of a person developing congestive heart failure increases. Heart damage can also be caused by infections, which can injure either the heart muscle or the valves that connect the chambers within the heart. Chronic alcohol and drug abuse also can damage the heart. Once the heart is injured, congestive heart failure often follows.

    Click to enlarge: What happens during a heart attack

    Figure 02. What happens during a heart attack

    Diseases that make the heart work harder, such as chronically high blood pressure and lung disease, may weaken the heart and lead to congestive heart failure Figure 03. High blood pressure (hypertension) forces the heart to pump harder, eventually causing the chambers of the heart to become larger and weaker. Serious lung disease, such as asthma or emphysema, reduces the amount of oxygen available to the heart, causing the heart to work harder to supply oxygen throughout the body. Diabetes also places an increased strain on the heart, which can lead to congestive heart failure.

    Click to enlarge: Blood pressure chart

    Figure 03. Blood pressure chart

    Heart damage present at birth can cause congestive heart failure. Some people are born with abnormalities in the structure of the heart muscle or valves. Because other parts of the heart compensate for the weakness, the heart overall is damaged, making it more likely that the person will develop congestive heart failure.

    Fatigue, shortness of breath, and swelling in the legs are common symptoms of congestive heart failure. Because tissues do not receive enough nourishment if the heart is not pumping adequately, you may tire easily. Shortness of breath may worsen with activity, at night, or when lying down. You may even be awakened from sleep with a feeling of suffocation.

    If fluid pools in the lungs, you may experience a persistent cough. You also may cough up a pink, frothy substance, mucus, or blood. Fluid in the lungs results from the heart’s inability to pump out all the blood it receives. Fluid retention can cause sudden weight gain, and may collect in the lungs over a period of time. Blocked arteries, an irregularly beating heart, stress, or consuming a large amount of salt may increase the risk of your lungs filling with fluid.

    Fluid may also back up into the legs, arms, or abdomen, causing swelling and firmness. Other symptoms include irregular heartbeats or palpitations, feeling your heart pounding in your chest, loss of appetite or nausea, and confusion. The heart beats faster to try to make up for its limited pumping ability. The more rapid heartbeat may be irregular, or cause a feeling in the chest that the heart is racing. When the stomach and digestive system receive less blood, due to the heart’s failure to pump adequately, you may feel nauseous or full. Digestive symptoms also may occur due to swelling of the liver. Changes in blood chemistry levels can lead to confusion, memory loss, and impaired thinking.

    Factors that increase a person’s risk of heart attack, such as high cholesterol levels, obesity, and high blood pressure, also increase risk of congestive heart failure Figure 04. The same factors that contribute to other heart disease—hardening of the arteries, high cholesterol levels, obesity, high blood pressure, irregular heart rhythm, thyroid problems, diabetes mellitus, and a family history of heart disease or sudden death, increase the risk of congestive heart failure.

    Click to enlarge: BMI calculator

    Figure 04. BMI calculator

    Older people and African-Americans are at increased risk for the heart failure. People older than 65 are more likely than younger people to suffer from congestive heart failure. The condition is more prevalent among African Americans than whites.

    The doctor will perform a physical exam, listen to your heart, and ask about your medical history and that of your immediate family. Past medical problems and a family history of some heart problems may contribute to congestive heart failure. Knowing your health history helps the doctor figure out what is wrong. The doctor will check for fluid collecting in the legs, the abdomen, and in other parts of the body. The jugular vein in your neck may indicate increased pressure as a result of the heart not pumping blood effectively. This increased pressure provides a visible sign of trouble that may not be otherwise apparent. The doctor will also listen to your heart and lungs. In patients experiencing heart failure, the doctor will often hear an extra heart sound. Normally, the heart emits two sounds with each beat (generated by the closure of the valves). In heart failure, an extra sound is produced which is roughly similar in sound quality, but is characteristic of abnormal heart function. In addition, fluid in the lungs frequently produces abnormal lung sounds.

    The evaluation will include an investigation into what might have led to heart failure. Blood tests, urine tests, and other tests will be part of this investigation. In some cases an underlying condition exists that may have been with you for a long time. The doctor will assess you for hardening of the arteries, kidney and thyroid problems, and other imbalances in the body. Blood tests can check thyroid function, iron levels, and whether you have HIV or other diseases. A urine test helps to assess kidney function.

    An electrocardiogram, a simple and painless test that records the heart’s electrical activity on a graph, may aid in identifying underlying heart conditions.

    A coronary angiogram may be ordered to assess for blockages or buildup of fatty plaque in the arteries that surround the heart (coronary arteries).

    An angiogram is a test that is done by inserting a flexible catheter or tube attached to a guide wire into one of the veins in the groin. The catheter is then advanced through the blood vessels until it reaches the heart. A dye is then injected through the catheter into the bloodstream, and x-rays of the heart and coronary arteries are taken. The dye enables the doctor to identify blockages in the arteries.

    An echocardiogram, which uses sound waves to visualize the size, shape, and motion of the heart, assists in diagnosing congestive heart failure. Echocardiograms are used to examine the internal structures of the heart. The test allows doctors to observe the heart’s chambers and valves, as well as the blood vessels coming to and leaving the heart. An echocardiogram may be used in the future to monitor your response to treatment.

    A stress test or x-rays may be ordered to evaluate heart function. A heart-lung stress test measures oxygen consumption and monitors the heart (with a machine called an electrocardiogram), while a patient is exercising. The test also is helpful in determining if the current impairment is related to the heart or the lungs in patients with disorders in both. Chest x-rays are beneficial in assessing the lungs as well as the size and shape of the heart. A radionuclide ventriculogram, a type of nuclear-medicine test, can help determine how much the blood the heart is pumping.

    Preventative measures include taking steps to avoid heart disease and high blood pressure, and adequately treating existing heart conditions. To prevent heart failure and other cardiac conditions, maintain a healthy weight, eat a low-fat and low-cholesterol diet, stop smoking, limit alcohol intake, and exercise regularly. Take medications ordered by the doctor. Make time to relax and do the things you enjoy.

    Patients at risk for congestive heart failure should have their blood pressure checked regularly for possible hypertension (chronic high blood pressure).

    High blood pressure puts additional strain on the heart and can lead to congestive heart failure. Prompt detection allows for early treatment and control.

  • Prevention and Screening

    Preventative measures include taking steps to avoid heart disease and high blood pressure, and adequately treating existing heart conditions. To prevent heart failure and other cardiac conditions, maintain a healthy weight, eat a low-fat and low-cholesterol diet, stop smoking, limit alcohol intake, and exercise regularly. Take medications ordered by the doctor. Make time to relax and do the things you enjoy.

    Patients at risk for congestive heart failure should have their blood pressure checked regularly for possible hypertension (chronic high blood pressure).

    High blood pressure puts additional strain on the heart and can lead to congestive heart failure. Prompt detection allows for early treatment and control.

Heart Failure Related Drugs

Heart Failure Related Conditions