If you have symptoms of heart failure, your doctor will ask you to describe them in detail and you will have a physical examination.
If your doctor thinks you may have heart failure, you will probably need to have tests to find out more. These will include:
- blood tests, to check if there is anything in your blood that might indicate heart failure or some other illness
- an echocardiogram (an ‘echo’), which checks how well your heart is pumping
Blood tests
Blood tests can show whether you have another condition that may be causing your symptoms, such as anaemia, diabetes, thyroid problems or kidney disease. A blood test can also check whether the level of cholesterol in your blood is too high, as this is associated with coronary heart disease, which may lead to heart failure.
Natriuretic peptide test
Your blood sample will be tested for a substance called natriuretic peptide (also called BNP or NTproBNP). If your heart is damaged or overworked, it will secrete BNP into the blood and the test can detect these higher levels.
The test can also indicate the severity of your heart failure. Higher levels of BNP/NTproBNP in the blood can mean that you have more severe heart disease, while lower levels may indicate a milder form.
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Echocardiogram (or echo)
An echocardiogram (ECG) is used to look in detail at the structure of your heart. A pulse of harmless, high-frequency sound waves is passed through the chest wall and produce a picture by ‘bouncing back’ from the structures in the heart (in a similar way to an ultrasound scan in pregnancy).
For the test, you will be asked to lie on your left side with your left arm behind your head. Lubricating jelly is put on your chest and the ultrasound probe (recorder) is placed at various points on the chest between the ribs. The probe picks up echoes from the heart and shows them on the screen as a detailed picture (echocardiogram) of the structures of the heart.
The test allows the operator to find out a lot of information about the heart, including:
- how well the valves are working and whether any of them are damaged
- how well the heart is working as a pump (when the contraction of your heart forces blood to circulate around the body, called systolic function)
- how well the heart relaxes after pumping (when the heart relaxes after each contraction, allowing it to fill with blood, called diastolic function)
- whether there are holes in the walls between the chambers of the heart, disrupting the one-way system of blood flow and allowing blood to flow from one side to the other (intracardiac shunts)
The most important finding from an echocardiogram is usually a measurement of how well one of the chambers of your heart – the left ventricle – is pumping. The left ventricle pumps the blood around the body. This measurement, called the left ventricular ejection fraction (LVEF), is an estimate of how much of the blood that enters the left ventricle is pumped out when the heart muscle contracts.
In a healthy heart, about 60% of the blood entering the left ventricle gets pumped out when the heart muscle contracts. A value of less than 40% would indicate that the heart is not pumping well.
Sometimes different types of echocardiogram are performed. These include:
Stress echocardiogram
A stress echocardiogram is carried out to see how the heart functions when it has to work hard. It is performed by increasing the person’s heart rate, either by exercise on a treadmill or exercise bike or by the infusion of a medication.
Transoesophageal echocardiography
This test is carried out when doctors need to look at your heart structure in more detail. Pictures of your heart are taken from inside your body by passing a small probe mounted at the end of a thin flexible tube down your oesophagus (the tube that connects your mouth to your stomach).
Before the test, you may be given a mild sedative to help you relax and an anaesthetic will be sprayed on the back of your throat to make it easier to swallow the tube. While the probe is in your oesophagus, pictures of your heart are taken. The probe is then gently withdrawn.
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Other tests
You may also have other tests to help rule out any other causes of your symptoms. These may include:
- an electrocardiogram (ECG), which records the natural electrical activity in your heart
- a chest X-ray to check whether your heart is bigger than it should be and whether there is fluid in your lungs, which might indicate heart failure
- breathing tests to rule out any problems with your lungs
- blood and urine tests
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