To diagnose systolic heart failure, your healthcare provider will ask about your medical history and symptoms, perform a physical exam, and order testing.
Blood tests may be ordered to assess your heart, kidney and liver function.
Providing information about your heart’s electrical activity, an electrocardiogram can help your provider understand your heart rate and whether you have an arrhythmia. Alternatively, your provider might ask you to wear a monitor for a day or two to record how well your heart’s circuitry is working.
Your healthcare provider may order one or more advanced cardiovascular imaging tests to measure EF or look for additional signs of heart failure.
Coronary angiogram
Coronary angiography, also called a coronary angiogram, is a test that evaluates your coronary arteries to determine if a narrowing or blockage is present.
A coronary angiogram is performed in the cardiac catheterization lab. You will receive sedation to help you relax. Depending on your health and the reason for your angiogram, you may be awake or you may receive general anesthesia so you’re completely asleep.
Your provider makes a small incision in your groin or wrist. A catheter is then inserted into the incision. This flexible tube is guided to the heart, and then a special dye is released from the tube. The contrast dye spreads through your heart and blood vessels. X-ray pictures then highlight blocked arteries causing your symptoms.
If you have a blockage, your doctor may choose to treat it right away. This may be done by inflating a balloon on the end of the catheter to expand the artery and remove the blockage. During this procedure, known as angioplasty, a mesh tube called a stent is often placed to help the artery stay open.
Depending on your condition, you might be able to go home the same day as your coronary angiogram, or you might need to stay in the hospital longer.
Right heart catheterization
Right heart catheterization is a procedure that uses a catheter to monitor heart function, blood flow, and pressure in the heart and lungs. This procedure is also known as pulmonary artery catheterization.
A right heart catheterization is most often performed in the cardiac catheterization lab. You will receive sedation to help you relax. Most patients are awake during this test.
Your provider makes a small incision in your groin or neck and inserts a catheter into the veins. Using X-ray guidance, the catheter is guided through the heart and measures blood flow and pressure on the right side of your heart and into your lungs.
You will remain in the hospital for a few hours after right heart catheterization. Most patients can go home the same day.
Chest X-ray
A chest X-ray takes pictures of your heart, lungs and arteries. It can reveal signs of heart disease, such as enlarged areas or calcium deposits in your heart and fluid in your lungs.
Cardiac computed tomography angiography (CCTA)
This imaging test takes multiple X-rays to create a 3D computer model of your heart.
Echocardiogram (ECG or echo)
This type of test records activity of the heart using high-frequency sound waves, or ultrasound. A technologist called a sonographer conducts this test by applying gel to your chest that makes it easier for sound waves to reach your heart. The sonographer will then wave a transducer across your chest to send sound waves to your heart. The echo created by those waves is translated into images of your heart as it beats.
Cardiac MRI
This test uses magnets to create detailed images of the heart’s structure and show blood flow and heart valve function. Using cardiac MRI, your physician can diagnose heart valve disease by evaluating leaky or narrowed valves.
Cardiopulmonary exercise testing (CPET) measures how well your heart, lungs and muscles work together during exercise. It helps doctors understand how your body responds to physical activity and can be used to diagnose heart failure. It can also determine if you’re a fit for advanced treatments like ventricular assist devices or heart transplantation.
During the test, you will:
- Wear a mask: This measures how much oxygen you breathe in and how much carbon dioxide you breathe out.
- Be hooked up to heart monitors: Small, sticky patches (electrodes) are placed on your chest to track your heart’s electrical activity.
- Exercise on a treadmill or bike: The intensity gradually increases while your breathing and heart rate are monitored.
Also called a heart biopsy or cardiac biopsy, this is a medical procedure in which a small piece of heart muscle tissue is removed and examined under a microscope. It helps doctors diagnose certain heart conditions, such as inflammation (myocarditis), rejection after a heart transplant or rare heart diseases like amyloidosis.
A local anesthetic is applied to numb the area where the catheter (a thin tube) will be inserted — usually in the neck (jugular vein) or groin (femoral vein). Your doctor will then insert a catheter into the vein and guide it toward your heart using X-ray or ultrasound imaging. A special tool called a bioptome (tiny forceps at the tip of the catheter) is used to snip small samples of your heart muscle.
A heart biopsy is generally an outpatient procedure, and you can go home the same day.
