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.

Heart failure occurs when the heart doesn’t pump effectively. 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 liver
  • 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 heartbeats 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 gauge the fluid status in the body.

A common early symptom of heart failure is feeling tired more quickly than usual after mild exertion. As your heart muscles become 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: the New York Heart Association (NYHA) Classification and the American College of Cardiology and the American Heart Association (ACC/AHA) staging system. Two symptoms from both criteria must be present in order for a healthcare professional to make a diagnosis.

NYHA class

  • Class I: No symptoms of heart failure.
  • Class II: Symptoms of heart failure with moderate exertion, such as ambulating two blocks or two flights of stairs.
  • Class III: Symptoms of heart failure with minimal exertion, such as ambulating one block or one flight of stairs, but no symptoms at rest.
  • Class IV: Symptoms of heart failure at rest.

ACC/AHA staging

Stages of Heart Failure

Stage A:
At risk for heart failure
Individuals are at risk for heart failure but currently have no symptoms or structural or functional heart disease.
Risk factors: hypertension, coronary vascular disease, diabetes, obesity, exposure to cardiotoxic agents, genetic variants for cardiomyopathy and family history of cardiomyopathy
Stage B:
Pre-heart failure
Individuals have no current or previous symptoms of heart failure but have either structural heart disease, increased filling pressures in the heart, or other risk factors.
Stage C:
Symptomatic heart failure
Individuals currently have or previously had symptoms of heart failure.

Stage D:
Advanced heart failure
Individuals currently have heart failure symptoms that interfere with daily life functions or have had repeated hospitalizations due to symptoms.

Classes of Heart Failure

Class IAn individual’s typical physical activity does not cause extra fatigue, heart palpitations, or shortness of breath.
Class IIWhen an individual is at rest, they are comfortable, but typical physical activity causes fatigue, heart palpitations, shortness of breath, or chest pain.
Class IIIWhen an individual is at rest, they are comfortable, but slight physical activity causes fatigue, heart palpitations, shortness of breath, or chest pain.
Class IVAn individual has symptoms of heart failure while they are at rest, and physical activity causes them even more discomfort.

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.

Can a blood test detect congestive heart failure?

Yes. Blood tests can check for biomarkers that increase during heart failure like B-type natriuretic peptide (BNP) or pro-BNP. You may also have blood tests to determine if your liver and kidneys are functioning properly.

Can congestive heart failure be detected early?

Early diagnosis of congestive heart failure can be very important. Getting early treatment can be very helpful and may extend your life. Reporting symptoms that might be congestive heart failure to your doctor can help them make an accurate diagnosis. These symptoms include:

  • shortness of breath
  • coughing when lying flat
  • fatigue
  • weakness
  • difficulty concentrating
  • swelling in your lower limbs
  • abdominal swelling
  • weight gain

What are the signs your heart is quietly failing?

While heart failure may have no obvious symptoms at the early stage, some individuals with heart failure may have subtle signs and symptoms such as:

  • fatigue
  • shortness of breath
  • coughing
  • edema
  • decreased stamina

It’s important to talk with a doctor if you experience any of these.

What are the 4 stages of congestive heart failure?

The four stages of heart failure include:

  • Stage A (at risk for heart failure): You have no symptoms or heart disease, but you have risk factors like obesity, diabetes, a family history of cardiomyopathy, and others.
  • Stage B (pre-heart failure): You do not have current or previous symptoms of heart failure, but you do have either structural heart disease, increased filling pressures in the heart, or other risk factors.
  • Stage C (symptomatic heart failure): You have current or previous symptoms of heart failure.
  • Stage D (advanced heart failure): You have symptoms of heart failure that interfere with your daily life functions, or you have repeated hospitalizations due to your symptoms.

What is the best lab test for congestive heart failure?

The B-type natriuretic peptide (BNP) blood test is one of the best blood tests to detect heart failure. This test measures the levels of BNP hormone in your blood.

BNP helps keep your veins and arteries dilated and plays a role in fluid balance in the body through effects on the kidneys. If you have heart failure, your heart produces more BNP, so a higher BNP test may indicate heart failure.

What is the most accurate test for congestive heart failure?

There’s not a single “most” accurate test for congestive heart failure. Diagnosing congestive heart failure involves a combination of things like an accurate medical history, a physical examination, blood testing, and imaging tests.

Imaging tests may include an echocardiogram to look at your heart’s structure and how well it works and other imaging tests like stress echocardiogram, nuclear imaging, cardiac magnetic resonance imaging (MRI), and cardiac computed tomography (CT).

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.