The sooner you know you have heart failure, the sooner you can be treated.
The term “heart failure” makes it sound like your heart has completely stopped working. A scary thought, yes, but it’s absolutely not true. More than 6 million Americans are living with heart failure; over 900,000 new cases are diagnosed each year. Heart failure is a very manageable and treatable condition.
Heart failure occurs when the heart muscle has weakened and can’t pump blood well enough to meet the body’s needs. “Heart failure is a condition in which either your heart doesn’t pump well, or your heart doesn’t relax well,” says Michelle Weisfelner Bloom, MD, cardiologist at Stony Brook University Medical Center.
Even though your heart is still pumping, heart failure can significantly affect your quality of life. It can cause trouble breathing and sleeping, chronic fatigue, swelling and pain, and feelings of depression.
That’s why if you’re noticing any symptoms of heart failure, it’s imperative that you make a doctor’s appointment to see what’s going on, so if it does turn out to be heart failure, you can get the proper treatment. “Heart failure can be heart success if you really make it into a life event,” says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital in New York City. That means getting diagnosed, following your doctor’s treatment plan, and making lifestyle changes to improve heart failure.
How Cardiologists Diagnose Heart Failure
There are no routine screenings for heart failure; the initial doctor’s visit is often due to a patient’s concern about any of the following symptoms:
- Shortness of breath
- Persistent coughing or wheezing
- Buildup of excess fluid in body tissues (edema)
- Unusual fatigue
- Lack of appetite or nausea
- Impaired thinking
- Increased heart rate
Doctors may also perform a physical exam, checking your heart, lungs, legs and veins.
Tests Doctors Use to Diagnose Heart Failure
Depending on the results of the initial physical exam, doctors may then decide to order certain tests or procedures to help them understand the root of the problem.
Electrocardiogram (EKG): “If you’re coming into my office and you have new onset shortness of breath, the first thing we always do is get an EKG,” says Dr. Bhusri. An electrocardiogram (EKG) is a machine with wires that attaches to your chest. It records your heart’s rhythm, frequency of beats and electrical conduction. The EKG results will tell the doctor whether you’ve had a heart attack, if the left ventricle has thickened (an enlarged heart muscle wall), or the heart rhythm is abnormal.
Blood work: If blood work is ordered, a sample of blood will be drawn from your arm. The blood sample is then analyzed for levels of certain biomarkers and substances to help diagnose heart failure and predict outcomes.
X-ray: An X-ray may be ordered to take images of your chest. An X-ray can help the doctor see if the heart is enlarged or there is congestion in the lungs.
Echocardiogram: “An echocardiogram is the fundamental imaging modality we use to help us visualize the heart in four dimensions,” says Dr. Bhusri. “We can see the heart pumping in real time. I can look at all of the walls and the doors (i.e. the valves), and see which ones are functioning well and which ones are functioning weakly.”
Cardiac catheterization: Cardiac catheterization is a procedure in which a very small tube is inserted into a blood vessel in your thigh or arm. The tube is then positioned either in the heart, or at the beginning of the arteries that supply blood to the heart. A dye is then injected, which allows doctors to see into the arteries via X-ray. This helps them find any blockages that may be in the arteries or parts of the heart that may be weakened or damaged by lack of blood.
After the tests to diagnose heart failure are performed, the doctor will determine if you have heart failure, what type of heart failure you have, and how severe it is. This will then help them determine which heart failure treatments and lifestyle modifications will best fit your needs.
“You only have one heart, and to know that your heart is failing, is a stark reality for people to take in, but they have to, because we have to initiate treatment right away.” says Dr. Bhusri. “We have now devices and medicines that can actually bring you back to the same lifespan.”
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.Satjit Bhusri
Dr. Bhusri is an attending cardiologist at the Lenox Hill Heart & Vascular Institute and an assistant professor of cardiology at Hofstra Northwell School of Medicine.Rachel Bond
Dr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.
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You can diagnose heart
failure many different ways.
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You can start just by simply asking
a patient for their symptoms, or
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doing a physical exam to see whether or
not there's evidence that the heart isn't
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pumping well, or
the heart's not relaxing well.
00:00:15,368 --> 00:00:21,555
00:00:21,555 --> 00:00:25,589
Clinically it's diagnosed by
various maneuvers that we can do
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in the doctor's office.
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One is simply by listening to your heart,
listening to your lungs,
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examining your legs,
examining your neck fades.
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Outside of that, blood work, chest
X-rays and echocardiogram are essential.
00:00:41,890 --> 00:00:47,400
So, we don't routinely screen for heart
failure, we base it a lot on symptoms.
00:00:47,400 --> 00:00:52,080
If you're coming in to my office and
you had undue onset shortness of breath,
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the first thing we
always do is get an EKG.
00:00:54,620 --> 00:00:56,450
We get an EKG and we get vital signs.
00:00:56,450 --> 00:01:01,420
So the doctor may say, let's get
an EKG, which is basically stickers
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that we put on the chest that tells
us the electrical conduction.
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They may prompt you, if it's abnormal,
to get a sonogram of the heart,
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also known as an echocardiogram.
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And that's truly the way we're
able to diagnose heart failure,
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by seeing if the heart muscle is
not pumping as well as it should.
00:01:17,370 --> 00:01:22,500
An echocardiogram is
the fundamental imaging
00:01:22,500 --> 00:01:27,240
modality we use to help us visualize
the heart in four dimensions.
00:01:27,240 --> 00:01:29,630
We can see the heart pumping in real time.
00:01:29,630 --> 00:01:34,840
I can look at all of the walls and
the doors i.e., the valves, and
00:01:34,840 --> 00:01:38,170
see which ones are functioning well,
which ones are functioning weak.
00:01:38,170 --> 00:01:41,610
Is this patient having trouble
relaxation of their heart, or
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having areas of their heart
that are weak and not pumping?
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You can also do something called
a right heart catheterization,
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which is an invasive procedure where you
go into the hospital and we look with
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a cathetar to see what the pressures are
in the different chambers of the heart.
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And we can use that
information to figure out
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what we can change about the medications,
or whether or
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not a patient is sick enough to move on to
the next step in heart failure management,
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such as left ventricular assist device,
or even transplant.
00:02:08,980 --> 00:02:11,150
You only have one heart, and
00:02:11,150 --> 00:02:16,910
to know that your heart is failing is
a stark reality for people to take in.
00:02:16,910 --> 00:02:22,220
But they have to, because we have
to initiate treatment right away.
00:02:22,220 --> 00:02:27,232
We have now devices and
medicines that can actually bring you
00:02:27,232 --> 00:02:33,824
back to the same lifespan that you would
have had before having a heart failure.
00:02:33,824 --> 00:02:35,988
Common Tests for Heart Failure. American Heart Association. (Accessed on April 13, 2018 at http://www.heart.org/HEARTORG/Conditions/HeartFailure/DiagnosingHeartFailure/Common-Tests-for-Heart-Failure_UCM_306334_Article.jsp#.WtDXdpPwaL5)
Diagnosing Heart Failure. American Heart Association. (Accessed on April 13, 2018 at http://www.heart.org/HEARTORG/Conditions/HeartFailure/DiagnosingHeartFailure/Diagnosing-Heart-Failure_UCM_002047_Article.jsp#.WtDSSJPwaL4)