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Diagnosing Heart Failure


Updated November 14, 2011

When a patient has symptoms (such as shortness of breath, fatigue and/or swelling of the legs) that hint at heart failure, it is important for the doctor to make a definite diagnosis rapidly. In order to prescribe optimal therapy, and possibly more importantly, in order to increase the chances of halting or reversing the progression of heart failure, the doctor needs to know: a) whether a patient has heart failure, b) what type of heart failure the patient has, and c) what the underlying cause may be.

Does the Patient Have Heart Failure?

This is often the easiest question to answer. By taking a careful medical history and performing a careful physical examination, most of the time a doctor will come away from the bedside with an excellent idea of whether heart failure is present. Then, a definitive diagnosis can be readily made by performing an echocardiogram - a non-invasive method of creating an "image" of the beating heart.

What Type of Heart Failure Does the Patient Have?

There are three general types of heart failure: dilated cardiomyopathy (cardiomyopathy is heart muscle disease), hypertrophic cardiomyopathy, and diastolic dysfunction. While in general the physical examination is very helpful in distinguishing among these three types, a well-performed echocardiogram will virtually always reveal which type is present. On the echocardiogram, the enlarged, weakened ventricle typical of dilated cardiomyopathy is readily visible, as is the thickened heart muscle typical of hypertrophic cardiomyopathy. The cardiac changes seen with diastolic dysfunction are somewhat more subtle during echocardiography, but are nonetheless readily detectable as long as they are specifically sought.

What Is the Underlying Cause of Heart Failure?

Once the presence of heart failure is confirmed, it is vital to identify the underlying cause, especially in the case of dilated cardiomyopathy which is almost always a "secondary" condition - that is, it is almost always caused by some other (primary) condition. By identifying and aggressively treating the underlying cause, the progression of heart failure might be stopped or slowed. Common disorders that lead to dilated cardiomyopathy include coronary artery disease, hypertension, heart valve disease and viral infections. The echocardiogram will reveal any heart valve disease that may be present, but a heart catheterization might be necessary to look for coronary artery disease. Cardiac viral infections are often "diagnosed" by process of elimination, but sometimes measuring anti-viral antibodies in the blood can reveal specific viral exposures.

Hypertrophic cardiomyopathy is often genetic, but it can also be produced by aortic stenosis or high blood pressure, both of which can be treated. Aortic stenosis is readily diagnosed with the echocardiogram.

The cause of diastolic dysfunction is often not identifiable, but patients with this form of heart failure often have significant underlying high blood pressure, and they usually do much better once the their blood pressure is aggressively controlled.

More on Heart Failure

The Basics of Heart Failure

Symptoms of Heart Failure

Treating Heart Failure

Additional Links Related to Heart Failure


Massie, BM "Heart Failure" in: Goldman L and Ausiello D (Eds). Cecil Textbook of Medicine, WB Saunders, 2003

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