Common Tests for Heart Failure

To determine whether you have heart failure, your healthcare team may perform some or all of these diagnostic tests and procedures.

Physical examination

How it's done:

• You'll be asked about your medical history and symptoms. Typically, you fill out forms with this information before your examination. The doctor or a healthcare assistant may ask you the questions again during the exam.
• Your blood pressure will be taken.
• You'll be weighed.
• A healthcare professional will listen to your heart and lungs using a stethoscope.
• The physical exam is generally painless.

Tips for success:

• Don't be afraid to "look bad." For instance, if you smoke, eat a lot of high-fat foods or are physically inactive, be honest. That information helps determine your risk for heart failure.
• Your doctor can't make an accurate diagnosis without your full input. Think of your healthcare providers as your partners. You have to work together to be successful. Follow all instructions in preparation for your exam. You may be told not to eat or drink anything for a certain amount of time before your appointment.
• Bring all your medications, or a list of all your medications, to your appointment. That includes over-the-counter drugs, vitamins and supplements as well as prescriptions.

Blood tests

How blood tests are performed:

• Either in your doctor's office or in a lab, a sample of blood is drawn from your arm.
• The sample is then analyzed for levels of important substances, such as sodium and potassium (sometimes called electrolytes), albumin (a type of protein), creatinine (which is connected with kidney function) and certain biomarkers, which can help diagnose heart failure and predict outcomes.

What blood tests show:

Abnormal results may indicate a strain on the heart or on other organs such as the kidneys and liver, which often results from heart failure.

Chest X-rays

X-rays are painless. Here's how they're performed:

• X-rays are taken while you stand up or lie down on a table.
• Views may be taken from the back, front and/or the sides.
• X-ray studies may be done in the doctor's office or in a separate radiology lab.

What X-rays reveal:

• Whether the heart is enlarged
• Whether there is congestion in the lungs

Learn more about chest X-rays.

Electrocardiogram (EKG or ECG)

Electrocardiograms are painless. Here's how an EKG is performed:

• Small electrodes (round plastic discs the size of a half dollar) are placed on your chest. Wires run from the electrodes to the EKG machine.
• The EKG machine then records your heart's rhythm, frequency of beats and electrical conduction.

What an EKG reveals:

• Whether you've had a heart attack
• If the left ventricle is thickened (enlarged heart muscle wall)
• If the heart rhythm is abnormal (noting any arrhythmias such as atrial fibrillation, or AFib)

Learn more about an electrocardiogram.

Echocardiography (abbreviated as "echo")

How echocardiography is performed:

• Echocardiography is an ultrasound test that uses sound waves to examine the heart's structure and motion.
• The patient lies motionless while a technician moves a device over the chest.
• The device gives off a silent sound wave that bounces off the heart, creating images of the chambers and valves.
• Echocardiography is generally painless.

What echocardiography reveals:

• The images produced by the echocardiogram can show how thick the heart muscle is, and how well the heart pumps. This is the most common test used to assess your heart's ejection fraction.

Learn more about echocardiography.

Exercise stress test

How an exercise stress test is performed:

• You'll be hooked up to equipment to monitor your heart.
• You'll walk slowly in place on a treadmill. Then the treadmill's speed will be increased for a faster pace, and the treadmill will be tilted up to produce the effect of going up a small hill.
• You may be asked to breathe into a tube for a couple of minutes.
• Your heart rate and rhythm, breathing and blood pressure, and how tired you feel, will be monitored during the test.
• You'll be asked to keep up the pace for as long as you can, but you can stop the test at any time, if needed.
• Afterward, you will sit or lie down while your heart and blood pressure are checked.
• The test is painless, although you may feel as though you're exercising strenuously during the test.

An exercise stress test:

• Shows whether your heart responds normally to the stress of exercise.
• Reveals whether the blood supply is reduced in the arteries that supply your heart.
• Can help determine the kind and level of exercise that's appropriate for you.

Learn more about exercise stress test.

Radionuclide ventriculography or multiple-gated acquisition scanning (abbreviated as MUGA)

How the procedure is done:

• Radioactive substances called radionuclides are injected into the bloodstream.
• Computer-generated pictures can then display the locations of the radionuclides in the heart.
• It's a painless procedure, outside of a shot or an IV (an intravenous drip line).
• There's no lasting effect from the radionuclides.

What the procedure shows:

• How well the heart muscle is supplied with blood
• How well the heart's chambers are working
• Whether part of the heart has been damaged by heart attack

Learn more about Radionuclide Ventriculography or Radionuclide Angiography (MUGA Scan).

Cardiac catheterization

How the procedure is done:

• A very small tube (catheter) is inserted into a blood vessel in your upper thigh or arm.
• The tip of the tube is positioned either in the heart, or where the arteries supplying the heart originate.
• A special fluid (called a contrast medium or dye) is injected. This fluid is visible by X-ray.
• The pictures that are obtained are called angiograms.
• This procedure may involve some discomfort from placement of the catheter. You may be required to rest in a certain position after the procedure.

What cardiac catheterization shows:

• Blockages in the coronary arteries are visible on the X-rays.
• The parts of your heart that are fed by the blocked or narrowed arteries may be weakened or damaged from lack of blood.

Learn more about cardiac catheterization.

Magnetic resonance imaging (MRI)

How an MRI is performed:

A radiologist or MRI technologist usually performs the scan in a hospital, clinic or imaging center using special equipment.

• You'll lie down on a moveable table that slides into the MRI machine. The machine looks like a long metal tube.
• Your technologist will watch you from another room. You can talk with him or her by microphone. In some cases, a friend or family member may stay in the room with you.
• The MRI machine will create a strong magnetic field around you, and radio waves will be directed at the area of your body to be imaged. You won't feel the magnetic field or radio waves.
• During the MRI scan, the magnet produces loud tapping or thumping sounds and other noises. You may be given earplugs, or you may listen to music with headphones to help block the noise.
• In some cases, such as for an MRA (magnetic resonance angiography), you may have an intravenous (IV) line in your hand or arm for injecting a contrast agent into your veins. The contrast agent produces better images of your tissues and blood vessels. It does not contain iodine and is less likely to cause an allergic reaction compared to the agents used for computed tomography (CT) scans.
• An MRI scan lasts between 30 and 90 minutes.

What an MRI reveals:

• An MRI can show your heart's structure (muscle, valves and chambers) as well as how well blood flows through your heart and major vessels.
• An MRI of the heart lets your doctor see if your heart is damaged from a heart attack, or if there is lack of blood flow to the heart muscle because of narrowed or blocked arteries.

Learn more about MRI.