What's Involved with Heart Failure Diagnosis?

In most cases, heart failure develops slowly from long-term medical conditions.  Heart failure can also start suddenly, however, after a medical condition, event, or injury to the heart muscle (such as with a heart attack). Sometimes a diagnosis of heart failure is a surprise.  If your loved one has been diagnosed with heart failure, they may not have any symptoms. As the condition progresses, symptoms range from mild to severe and can be constant or come and go.

Simple physical changes that increase or do not resolve could indicate an important change in their condition.   During your loved one's next visit to their primary care provider, share these subtle or ongoing changes. Most of the time, a person will tell their healthcare provider “I’m fine” because these gradual changes are now normal for them and they may not recognize those changes indicate a larger problem.

What is CHF?

Heart failure — often known as congestive heart failure (CHF), which is left-sided heart failure and the most common type — is a serious and life-limiting condition wherein the heart doesn't pump blood as well as it should.*

Despite the name “heart failure”, it doesn’t mean that the heart has actually failed or is about to stop working.  It means that the heart muscle has weak contraction that limits its ability to eject blood.

This can cause blood to pool or back up in the heart, causing additional problems in the lungs and throughout the body, as well as furthering the heart's weakness.

With or without treatment, heart failure is progressive, meaning it gradually gets worse.  More than 5 million people in the United States have CHF. It’s the most common diagnosis in hospitalized patients over age 65.

*While left-sided heart failure is the most common type, right-sided heart failure does occur - and on rare occasions, before left-sided heart failure (such as in cases of pulmonary hypertension, or high blood pressure in the lungs). The left side of the heart pumps blood out to the body, and the right side of the heart pumps blood to the lungs. Over time, left-sided heart failure can lead to right-sided heart failure.

Heart Failure: Quick Facts

• More than 6 million U.S. adults have heart failure.

• With or without treatment, heart failure is progressive, meaning it gradually gets worse.  

• It’s the most common diagnosis in hospitalized patients over age 65. 

What can you do for your loved one?

• No matter their age, accompany them to visits with their primary care provider and specialists.

• Observe for subtle changes in demeanor or physical well-being and report the changes to those providers. 

• Ask your loved one how they feel physically and psychologically, encourage them to be honest and open with you about their experiences, and then encourage them to speak up to their providers.

• Be alert for new or increased signs and symptoms, subtle changes in areas like appetite, sleep, and toileting, and indicators of depression.

• Don't assume that signs and symptoms are due to existing heart failure, as there are many other possible causes, including other serious heart and lung conditions. Don't try to diagnose, call their provider.

Symptoms of CHF?

At first, there may be no symptoms or only mild symptoms. As the disease progresses, symptoms will be more bothersome.

The symptoms of heart failure depend on which side of the heart is affected (left or right) and how serious the condition has become. Most symptoms are caused by reduced blood flow to organs and fluid buildup in the body.

• Shortness of breath with activity or when lying down (frequently the first noticeable symptom)

• Continued fatigue or weakness, even after rest

• Reduced ability to exercise

• Persistent cough or wheezing 

• Swelling in the legs, ankles, feet, or belly (abdomen)

• Difficulty sleeping while lying flat

• Nausea and loss of appetite

• Needing to urinate (pee) often

• Rapid or irregular heartbeat

• Very rapid weight gain from fluid buildup (2 lb. overnight or 5 lb. in a week)

• Difficulty concentrating or decreased alertness

• Chest pain, especially if heart failure was caused by a heart attack

When to see a doctor

If you think your loved one might be experiencing signs or symptoms of heart failure, make an appointment with their provider.

Call 9-1-1 if they have any of the following:

• Chest pain

• Severe weakness or fainting

• Rapid or irregular heartbeat with shortness of breath or lightheadedness

• Sudden, severe shortness of breath and coughing up white or pink, foamy mucus

Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other serious heart and lung conditions. Don't try to diagnose yourself, contact a provider or emergency services.

Diagnosis

There’s no one test to diagnose heart failure. All the following are considered: 

• Medical history, including symptoms

• Family history, including relatives who have had heart problems

• Physical exam

• Electrocardiogram (EKG): A painless test that reads the heart’s electrical activity, including beat pattern and any disruptions in the electrical circuit

• Chest X-ray: A picture of the heart, lungs, and other chest structures that reveals whether the heart is enlarged or there are signs of lung damage

• B-type natriuretic peptide (BNP) blood test: BNP is a hormone marker of the stretch or strain that the heart is under and helps determine the severity and prognosis of heart failure

• Echocardiogram: An ultrasound image of the heart function. This differs from a Doppler ultrasound, which gives a picture of blood flow to the heart and lungs

• Holter monitor: A wearable device (usually 24 to 48 hours) that continuously records the heart’s electrical activity

• Exercise stress test: A treadmill or stationary bicycle test to gauge how the heart performs during hard work. Some are unable to perform the exercise test, so heart stress will be induced by an injectable drug that causes a similar reaction

• In some cases, the provider may make a referral to a cardiologist (a doctor who specializes in the heart) for additional tests, diagnosis, and treatment

If your loved one already has a diagnosis of heart failure and any of the symptoms suddenly become worse or a new symptom develops, it may mean that existing heart failure is no longer responding to treatment or getting worse. Promptly contact the provider.