Though the term “heart failure” suggests that the heart has stopped working, what it really means is that the heart has become weaker or stiffer and no longer pumps as effectively as it once did.

As a result, blood flow to all the organs and tissues in your body is less efficient if you have heart failure. This can lead to some potentially serious complications and symptoms.

In addition to a physical exam and a review of your symptoms, your doctor can use several tests to help diagnose heart failure. Read on to learn more.

One of the first things a healthcare professional will do is review your symptoms and perform a physical exam.

As part of your physical exam, they will:

  • take your weight by having you stand on a scale
  • check for swelling in your lower limbs or in the abdomen
  • check for an enlarged kidney
  • listen to your heart and lungs with a stethoscope to check for sounds that may indicate a buildup of fluid in your chest
  • listen to your heart beats and other sounds to help them determine whether your heart is functioning as expected

Your doctor may also do a jugular vein pressure (JVP) exam as part of a physical exam. During a JVP exam, they can measure the bulge of your jugular vein to help determine if there is pressure in your vena cava. The vena cava is a large vein that brings blood to your heart.

A common early symptom of heart failure is feeling tired more quickly than usual after mild exertion. As your heart muscles becomes weaker and the condition progresses, symptoms may also include:

  • shortness of breath
  • coughing, especially when lying flat
  • fatigue
  • weakness
  • difficulty concentrating
  • swelling in your lower limbs or abdomen due to fluid retention
  • weight gain

Be sure to review all your symptoms with the doctor, even if you aren’t sure whether they are relevant. A review of your symptoms, as well as several tests of your heart function, will help the doctor make an accurate diagnosis.

Your doctor may use one or more of the following tests to help diagnose heart failure:

  • Blood tests will help a doctor check for biomarkers — such as B-type natriuretic peptide (BNP) or pro-BNP — that increase during heart failure.
  • An echocardiogram, or echo, is a noninvasive test that uses sound waves to measure your heart’s ejection fraction. This is the percentage of blood in the left ventricle that is pumped out to the body. It is an important sign of how well your heart pumps blood.
  • Cardiac CT scans and cardiac MRI scans can reveal heart anatomy and function.
  • Cardiac catheterization can tell a doctor whether your blood vessels are blocked. For this test, a healthcare professional will place a catheter into a blood vessel, then guide it to your heart.
  • An electrocardiogram, sometimes called an ECG or EKG, involves electrodes placed on your chest and attached to a computer to record your heart rate.
  • A Holter monitor is a portable ECG that can be worn for hours or days at a time.
  • A stress test helps a doctor assess how your heart functions during physical activity. It’s usually done on a treadmill or stationary bicycle.
  • A chest X-ray can check for an enlarged heart and fluid in or around your lungs.

The American Heart Association notes that you may undergo all or some of these tests depending on your symptoms and what the initial tests reveal.

The clinical criteria for diagnosing heart failure fall into two categories: major and minor. Two symptoms from both the major and minor criteria must be present in order for a healthcare professional to make a diagnosis.

Major criteria

  • sudden fluid buildup in the lungs, known as acute pulmonary edema
  • cardiomegaly, or an enlarged heart
  • bulging of the jugular vein, known as jugular vein distention
  • hepatojugular reflux, which causes neck vein distention when pressure is applied to the liver
  • sensation of shortness of breath when lying down or asleep, known as paroxysmal nocturnal dyspnea
  • pulmonary rales, or a rattling or bubbling sound in the lungs
  • third heart sound, which is identified by a brief heart vibration when the heart relaxes in between beats
  • weight loss of greater than 10 pounds (4.5 kilograms) in 5 days in response to treatment

Minor criteria

  • swelling in your lower legs due to fluid retention, known as ankle edema
  • sensation of shortness of breath when physically active, known clinically as dyspnea on exertion
  • enlarged liver, or hepatomegaly
  • coughing at night, usually when lying flat, known as nocturnal cough
  • fluid buildup around the lungs, also known as pleural effusion
  • tachycardia, or a resting heart rate faster than 120 beats per minute

Once heart failure is diagnosed, your doctor will also determine a particular class and stage. This is based on the severity of your symptoms and the presence of cardiovascular disease, as well as how much your condition limits your physical activity.

The classification will then guide your treatment options. If you have acute heart failure, you will remain in a hospital, possibly on oxygen, until your health is stabilized.

Even if your heart failure is mild, your doctor may prescribe cardiac rehabilitation. During a cardiac rehabilitation program, you’ll learn about managing your condition and how to exercise safely.

A heart failure diagnosis also means lifestyle changes.

Remember that lifestyle changes don’t happen overnight. Talk with your doctor if you need help identifying where or how to get started.

Your doctor may recommend some or all of the following lifestyle changes:

  • little or no alcohol
  • no smoking
  • stress management
  • low sodium diet
  • fluid restriction
  • sufficient sleep
  • exercise, as determined by your healthcare team

Your doctor may also prescribe medications to control blood pressure. This may include a combination of:

  • beta blocker
  • mineralocorticoid receptor antagonist
  • angiotensin receptor blocker and neprilysin inhibitor
  • sodium-glucose co-transporter 2 inhibitor

You may need treatments such as heart surgery, an implantable cardioverter defibrillator, or a mechanical heart pump. In severe cases, a heart transplant is a last resort option.

Heart failure is a serious condition that must be managed for the rest of your life.

See a doctor right away if you develop symptoms such as shortness of breath, unusual fatigue, or coughing or shortness of breath when lying down.

Several easily tolerated tests can be done to determine the strength of your heart and whether lifestyle changes, medications, or other treatments are necessary to keep your heart pumping for a long time.