When you or someone you're caring for is having symptoms of heart failure, it can be confusing and scary. Heart failure symptoms can be similar to symptoms of COPD and other cardiac conditions, so it's important to find out exactly what you're dealing with. Here are three steps to getting a clear and accurate diagnosis of heart failure (sometimes referred to as congestive heart failure).
1. Keep a good record of symptoms.
Because heart failure can affect so many bodily systems, the doctor will need to know as much as possible about symptoms. Keep a record of all the symptoms you're noticing, even if you're not sure they're heart related. When you notice any signs of fatigue, pain, sleep or breathing difficulties, lack of appetite, or other issues, write them down. Note the following:
- The date and time the symptom occurred
- How long it lasted
- What it felt like or what you observed
- How severe the symptom was
- How much it affected your or your loved one's quality of life
When it comes to a symptom such as pain or fatigue, the doctor may ask you to rate it on a scale of 1 to 10. If you're comfortable using a numeric system, rate each symptom as you write it down so you'll be ready to answer this question. Before your doctor visit, total up how often a particular symptom has been occurring, and if you've noticed any pattern, such as whether a symptom always occurs at night or after meals, or whether it's having an effect on mood. It's also important to keep track of any changes in weight and girth (waistline size).
2. Find the right doctor or specialist.
As a rule, look for a doctor who specializes in heart failure or has a great deal of experience managing this condition. This may be a cardiologist or a clinic that specializes in heart failure, or it may be a general practitioner or a geriatrician who has many patients with heart failure.
Note that although cardiologists specialize in heart conditions, many take an "interventionist" approach and are most comfortable ordering surgery and other procedures. When it comes to treating heart failure, this approach may not be the most helpful one, as your primary concern is going to be long-term symptom management, primarily with medications.
For anyone over age 80 seeing a cardiologist or a regular doctor, it can also help to add a geriatrician to his medical team who can double-check whether prescribed medications are appropriate for older patients and are in the right dosages.
When evaluating a doctor's personality and style, look for a doctor with a proactive approach who's optimistic about your or your loved one's potential to regain quality of life and therefore will be aggressive in pursuing this goal. Heart failure is notoriously undertreated. But with adequate treatment, it can reverse itself to some degree.
In fact, 27 percent of all heart failure patients experience some degree of reverse remodeling of the heart, which means the heart shrinks to closer to its normal size and regains some of its earlier strength and function. Once you've received a diagnosis of heart failure, you can move on to a treatment plan.
Another way to ensure an accurate heart-failure diagnosis
3. Get the right tests.
When you visit the doctor to discuss possible heart failure, make sure she orders a full workup, since heart failure is easily missed. Here's a list of what's most important:
A physical examination. It's best for the doctor to look at all parts of the body to look for telltale signs of heart failure, such as abdominal swelling. It's also important that the doctor give you or your loved one a chance to describe symptoms such as anxiety, palpitations, and a feeling of congestion or pressure in the chest.
Heart-function tests. A number of tests are available to analyze heart health and, more specifically, how effectively the heart is pumping blood. Not every test is appropriate or necessary for each patient, but make sure sufficient testing is done to get a clear picture of heart muscle strength and ability to pump blood. Important tests to ask for include these:
A chest X-ray. These are done to show fluid in the chest cavity. This can be one of the fastest and most effective ways to determine if congestion, or fluid buildup in the chest, is occurring.
An electrocardiogram (ECG or EKG). This electrode test monitors the electrical activity of the heart and helps the doctor check for arrhythmias and tachycardia, which often occur with heart failure and can be used to determine its severity.
An echocardiogram. This test uses ultrasonic sound waves to measure the size of the heart's structures, including the size of each chamber. With these test results, the doctor can look at systolic versus preserved systolic function and calculate the "ejection fraction" (a term you'll hear often), which indicates the percent of blood emptied from the heart's ventricles during each pumping cycle.
A cardiopulmonary stress test. This treadmill test uses a special mouthpiece to measure "gas exchange," the amount of oxygen breathed in and the amount of carbon dioxide breathed out during exertion. It also measures heart rate, respiratory rate, and blood pressure. Together, these measures tell the doctor how the heart is functioning under physical stress, which can determine the severity of heart failure.
An angiogram. Although it's not necessary in all heart failure diagnoses, an angiogram -- a dye-enhanced X-ray of the arteries and the heart chambers -- can be important if the person being tested has been experiencing any angina (chest or heart pain). An angiogram is useful in showing any narrowing of the arteries from blockages and can also detect aneurisms.
Kidney-function tests. As the heart weakens, it can affect blood flow to the kidneys, preventing these organs from doing their job of flushing wastes from the body. The doctor will run several lab tests to test levels of creatinine and blood urea nitrogen (BUN) to analyze how well the kidneys are functioning. Because heart failure and kidney failure both cause the general symptom of fluid overload, the doctor needs to rule out kidney failure as a primary cause to arrive at a diagnosis of heart failure.
BNP serum test. This relatively new blood test (the initials stand for "B-type natriuretic peptide serum") measures the level of a hormone released when the heart chambers stretch larger than normal, as they do during heart failure. But while a high level of BNP is a good indicator for heart failure -- and can tell a doctor to do additional testing -- a low level of BNP doesn't rule out heart failure, so the test can be used accurately only with this understanding.
More tests to evaluate overall health. A number of other conditions can both contribute to and result from heart failure, including diabetes, anemia, and thyroid problems. To understand how heart failure is affecting you or the person you're caring for, the doctor may run additional tests such as blood counts to look for anemia, glucose tolerance for diabetes, TSH for thyroid, and liver-function tests.