Early detection of congestive heart failure (CHF) significantly increases effectiveness in the treatment of CHF. Proper diagnosis requires seeing a cardiologist.
Cardiologists begin to diagnose CHF first using medical history. The doctor will be looking for risk factors such as high blood pressure. They may ask numerous questions pertaining to the family medical history. Provide the doctor with as much information as possible.
To diagnose CHF, doctors will perform a thorough physical exam and medical history. The doctor will use a stethoscope extensively in the physical, listening for abnormal heart sounds, or congestion in the lungs. They will check for swelling in the legs, ankles, feet, abdomen, and neck veins. Doctors also typically use the following diagnostic procedures:
Blood tests - The doctor will have your blood sample examined to determine kidney and thyroid function, possible disease affecting the heart, and chemical markers specific to CHF such as BNP (Brain Natriuretic Peptide). An overworked or injured heart will actually produce this hormone at high levels.
Cardiac catheterization - Named for the small flexible tube, or catheter, that the doctor uses to study the heart and coronary arteries in detail, checking for blockage, blood flow, ventricle health, and blood pressure. The catheter is usually inserted into a blood vessel in the arm or thigh, and threaded through to the heart.
Cardiac magnetic resonance imaging (MRI) - This non-invasive scan displays the beating and structure of the heart in detail, detecting damage and early signs of CHF even when no symptoms have manifested.
Cardiac CT scan - This scan has proven especially useful in the diagnoses of those who are already determined to have heart failure. The test can reveal previous heart attack or unusual causes of CHF.
Chest x-ray - Useful in checking the size of the heart, presence of fluid in the lungs, and overall heart and lung health.
Coronary catheterization (angiogram) - Similar to cardiac catheterization, except the catheter is threaded through the aorta. Coronary arteries are made visible on x-ray by injecting a dye via the catheter tube. Not only can arteries be checked for disease, but also heart valves, and the left ventricle (an additional test known as a ventriculogram).
Doppler imaging – This test is often performed in tandem with an echocardiogram, speed and direction of blood flow are measured using sound waves. Right-side heart failure is more easily diagnosed with this test.
Electrocardiogram (ECG) - Electrodes applied to the skin pick up the heart's electrical impulses, which can be seen over a monitor and recorded on paper read out. A doctor can detect rhythm problems or damage from heart attack via this test.
Echocardiogram - Much like an ultrasound, sound waves create a video image of the heart. Pumping ability can then be measured in the left ventricle (termed "ejection fraction") as well as diagnosing systolic or diastolic heart failure.
Ejection fraction – This test is a measurement of the percentage of blood pumped from the heart. 60 percent ejection fraction is average in a healthy heart.
Nuclear heart scan – During a nuclear heart can, a radioactive solution is injected into the bloodstream rendering heart vessels and chambers more visible on camera. Healthy heart muscle becomes illuminated, and damaged muscle does not. The doctor may opt to do this scan during a stress test.
Positron emission tomography (PET scan) - This scan is more accurate in determining problems with blood flow, and the heart's chemical activity levels.
Stress test - The heart and arteries are observed during stress created through exertion, whether via medication or exercise equipment (bike, treadmill). Echocardiograms, nuclear scans, or oxygen uptake tests may be performed in conjunction with this test to check for artery blockage, and how well the body has adjusted to the CHF.
Thyroid function tests - Abnormal thyroid hormone levels are a determinant in heart failure. Stimulation of the thyroid in conjunction with blood tests and scans can ascertain thyroid health.
As in adults, the doctor may order certain diagnostic tests for children or infants, including a cardiac catheterization and/or MRI, chest X-ray, electrocardiogram, echocardiogram and stress test. However, doctors look for certain signs of CHF in babies. These include:
CHF is a chronic condition requiring careful monitoring over a person's lifetime. The good news is that when caught early, proper treatment can restore healthy heart function. With proper treatment, many aspects of heart failure can be corrected or even reversed. Doctors have a number of options available to them, from surgical repair and heart rhythm adjustment, to medications and heart devices. Good detection will dictate treatment methods. The section titled Congestive Heart Failure Treatments provides more detailed information here.
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