Common Tests For Heart Failure
If you suspect you have symptoms of heart failure you should talk to your doctor .
Your doctor will likely perform a thorough examination of your body and will ask you about your symptoms, your medical history and your lifestyle. It is important that you answer any questions as honestly and accurately as possible so that your doctor can make an accurate diagnosis and can work with you to find the best treatment.
If your doctor suspects you have heart failure he or she will probably suggest you have certain tests. These tests will help to show whether your heart is working properly and, if not, where the problem lies.
This section explains the tests your doctor may want you to have and what the test can show. Click on any of the tests to learn more.
The most common tests are:
Who Should Get Tested For Heart Failure
You should order CHF labs if:
- You have other heart-related conditions such as coronary artery disease or high blood pressure.
- There is a family history of heart failure.
- The heart muscles have been damaged or inflamed.
- You have a disease that can lead to heart failure, such as diabetes or thyroid disorder.
- You have risk factors such as smoking, drinking too much alcohol, or obesity.
- You experience symptoms such as fatigue, shortness of breath, swollen stomach, legs, or feet, chest pain, or a chronic cough.
You may also order a blood test for CHF if your doctor suggests lab work will help with a diagnosis.
What Did It Find
- 104 out of 304 participants were confirmed as having heart failure.
- The most accurate overall diagnosis came from using NTproBNP level alone at a low cut-off of 125 pg/ml. This had sensitivity of 94.2% , meaning that the majority of those with heart failure would be picked up by this test. Specificity was much lower at 49.0% meaning that about half of those without heart failure would be referred for an echocardiogram.
- Combining the clinical decision rule with the 125 pg/ml NTproBNP cut-off did not improve accuracy. It missed a few more people with heart failure while not improving the false positive rate, .
- Using NTproBNP alone at a higher cut-off 400 pg/ml led to fewer false positives meaning less people would be referred for heart failure unnecessarily, but sensitivity was low at 76.9% meaning that the blood test could not be used alone.
- Combining the clinical decision rule with the higher NTproBNP cut-off of 400 pg/ml had slightly better sensitivity but poorer specificity .
- Using the clinical decision rule alone gave very poor sensitivity of 44.2% and specificity of 64.0% .
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Medical History And Physical Exam
If you are experiencing symptoms, your NYU Langone cardiologist gathers information about your medical history. Your doctor also asks about your family history, because your risk for some types of cardiomyopathy increases if family members have had these conditions.
Next, your doctor conducts a physical exam, in which he or she uses a stethoscope to listen to your heart and lungs for sounds that occur when a person has cardiomyopathy and heart failure. He or she also looks for swelling in your legs and abdomen, which may be due to a buildup of fluid.
Quality Of Patient Care
Brigham and Womens Hospital is committed to providing all of our patients with the safest, highest-quality, most-satisfying care possible and follow established protocols that have been shown to improve patient outcomes. Our inpatient satisfaction survey, sent to patients to assess their total care experience, helps us to monitor what we are doing well and areas for improvement. We pride ourselves in the quality of patient care we provide and how we are measured compared with other hospitals.
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Troponin Testfor Heart Attack
Troponin is a type of protein found in your heart muscles. It isnt normally found in the blood and is released into the blood when heart muscles become damaged.A troponin test looks for the level of troponin in your blood. As more and more heart muscle gets damaged, greater amounts of troponin are released in the blood. Two types of cardiac troponin T and I are used as cardiac profile test to identify heart injury or damage. A high level of troponin in the blood may indicate you are having or recently had a heart attack.Some studies have found that troponin I is more specific and a better cardiac marker than troponin T blood test for heart attack.Remember that one heart blood test alone may not determine your overall risk of heart disease. If you think your lifestyle or family history can put you at risk of developing heart disease at an early age, get in touch with a doctor, book yourself blood test for heart blockage and heart Disease as advised, and improve your lifestyle habits.
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Table Of Cutoff Values
Table 2, below, summarizes the evidence-based cutoff values of BNP and NT-proBNP for ruling in and ruling out the diagnosis of heart failure in the dyspneic patient presenting to the emergency department.
Table 2. Evidence-Based BNP and NT-proBNP Cutoff Values for Diagnosing HF
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Criterion |
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BNP = B-type natriuretic peptide GRF = glomerular filtration rate HF = heart failure LR = likelihood ratio NPV = negative predictive value NT-pro-BNP = N-terminal proBNP PPV = positive predictive value = not specifically defined. * Derived from Breathing Not Properly data . Derived from PRIDE data . Derived from subset of Breathing Not Properly data . |
BNP and NT-proBNP levels are higher in older patients, women, and patients with renal dysfunction or sepsis. Atrial fibrillation has also been associated with increased BNP levels in the absence of acute heart failure. However, BNP levels may be disproportionately lower in patients who are obese due to fat metabolism or who have hypothyroidism or advanced end-stage heart failure . NT-proBNP plasma levels are also lower in obese heart failure patients relative to nonobese patients with heart failure, regardless of whether the etiology is ischemic or nonischaemic.
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Management Of Heart Failure
The major goals of treatment in heart failure are to improve prognosis and reduce mortality and to alleviate symptoms and reduce morbidity by reversing or slowing the cardiac and peripheral dysfunction. For in-hospital patients, in addition to the above goals, other goals of therapy are to reduce the length of stay and subsequent readmission to prevent organ system damage and to appropriately manage the co-morbidities that may contribute to poor prognosis .
The 2013 American College of Cardiology/American Heart Association updated guidelines , 2010 Heart Failure Society of America guidelines and the 2008 European Society of Cardiology guidelines, with varying levels of evidence, recommend the following for different categories of HF patients.
Is There Anything Else I Need To Know About A Natriuretic Peptide Test
Your health care provider may order one or more of the following tests in addition to or after you’ve had a BNP or NT-proBNP test:
- Electrocardiogram, which looks at heart’s electrical activity
- Stress test, which shows how well your heart handles physical activity
- Chest x-ray to see if your heart is larger than normal or if you have fluid in your lungs
You may also get one or more of the following blood tests:
- ANP test. ANP stands for atrial natriuretic peptide. ANP is similar to BNP but it is made in a different part of the heart.
- Metabolic panel to check for kidney disease, which has similar symptoms to heart failure
- Complete blood count to check for anemia or other blood disorders
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How Will I Find Out If I Have Heart Failure
Your doctor will diagnose heart failure based on your medical history, a physical exam, and test results. Bring a list of your symptoms to your appointment, including how often they happen and when they started. Also, bring a list of any prescription and over-the-counter medicines you take. Let your provider know if you have any risk factors for heart failure.
You may also be referred to a cardiologist for these tests and treatment. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases.
What Are The Most Common Symptoms Of Congestive Heart Failure
Swelling is the most common symptom of congestive heart failure. Often, swelling is most apparent in the extremities, especially in the legs and ankles, but it can occur in other parts of the body as well. Fluid collection in and around the lungs can cause shortness of breath , especially during physical activity or when lying down. Other common symptoms of heart failure include fatigue, loss of appetite, and weight gain.
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Physical Exam For Heart Failure
First, your doctor will want to know if you:
- Have other conditions such as diabetes, kidney disease, angina, high blood pressure, or other heart problems
- Drink alcohol, and how much
- Take medications, and which ones
Your doctor will also do a physical exam. They’ll look for signs of heart failure as well as other illnesses that may have weakened your heart.
During your visit, your doctor will:
- Listen to your heart
- Check your blood pressure
Theyâll also look at your appearance while you sit, do mild activity, and lie flat. People with mild or moderate heart failure may appear comfortable at rest, but when active, they often become short of breath. Those with heart failure may be uncomfortable if they lie flat for a few minutes.
Your doctor may check for fluid in your lungs with a stethoscope. People with heart failure may also have neck veins that are larger than normal, swelling of the legs or abdomen, or an enlarged liver.
How Do I Prepare For A Blood Test For Heart Function
If your healthcare provider asks you to fast, dont eat or drink anything except water for nine to 12 hours before your blood draw appointment. Its important to drink enough water to stay hydrated, though. This can make it easier for your provider to find your vein and get a blood sample, which makes it more comfortable for you. Many people like to schedule their lab appointment for first thing in the morning because its easier to fast while youre sleeping.
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What Happens During A Natriuretic Peptide Test
For a BNP test or an NT-proBNP test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Predictors Of Poor Outcome And High Mortality Rate
In HF patients, exercise intolerance characterized by the reduction in peak VO2/VO2 max capacity has been considered as the primary predictor of mortality and morbidity . In addition, higher age, increased blood urea nitrogen, creatinine and heart rate, lower systolic pressure and serum sodium, presence of dyspnea at rest, lack of long-term treatment with a -blocker, male gender and lower body mass index and hemoglobin levels have been identified as independent predictors of mortality. The following values have been shown to predict the increased mortality in inpatient settings/hospitals .
- Serum urea > 15 mmol/L
- Systolic blood pressure < 115 mmHg
- Serum creatinine > 2.72 mg/dL
- N-terminal pro-brain natriuretic peptide > 986 pg/mL
- Left ventricular ejection fraction < 45%
Some of the other predictors of relative poor outcome in chronic heart failure are given below.
- High NYHA functional class
- Reduced left ventricular ejection fraction
- Third heart sound
- Increased pulmonary artery capillary wedge pressure
- Reduced cardiac index
- Raised plasma catecholamine and natriuretic peptide concentrations
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Why Was This Study Needed
Heart failure is when the heart is not pumping blood around the body as well as it should. Around half a million people in the UK are living with heart failure. It is a serious and long-term condition, but can be managed to help people to control their symptoms.
Timely and accurate diagnose is important. People often present to their GP with tiredness, breathlessness or swollen legs. However, symptoms can develop gradually and can be confused with other conditions.
Clinical decision rules are a way of assessing how likely the diagnosis is based on the presence of characteristic features, like previous heart attack. They aim to help GPs make consistent and evidence-based decisions.
This study looked at the best way of identifying heart failure: using only the rule, combining the rule with a blood test, or doing the blood test only.
What Is A Cardiac Risk Assessment
This is a group of tests and health factors that have been proven to indicate your chance of having a cardiovascular event such as a heart attack or stroke. They have been refined to indicate the degree of risk: borderline, intermediate, or high risk.
Perhaps the most important indicators for cardiac risk are your personal health history. These include:
- Pre-existing heart disease, or already having had a heart attack
There are some imaging tests that may be used in cardiac risk assessment. Non-invasive tests may include, for example, an electrocardiogram or a stress test, also called ECG stress test or metabolic stress test. Invasive tests may also be used to evaluate for the presence of cardiovascular disease , but they are usually used for diagnostic purposes in people with signs and symptoms and not for risk assessment. Examples include an angiography/arteriography and cardiac catheterization.
The lipid panel is the most important blood test for cardiac risk assessment.
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The Role Of Blood Tests For Heart Failure
Physicians often order heart failure lab work to help diagnose congestive heart failure. These blood test results may guide physicians in ordering other tests, such as chest x-rays or magnetic resonance imaging , to support the diagnosis.
With Personalabs, you can order specific blood tests for heart health online, then take the order to one of our 4,000-plus affiliated labs across the country to get fast, accurate results.
Stages Of Heart Failure
When you’re diagnosed with heart failure, your doctor will usually be able to tell you what stage it is.
The stage describes how severe your heart failure is.
It’s usually given as a class from 1 to 4, with 1 being the least severe and 4 being the most severe:
- class 1 you don’t have any symptoms during normal physical activity
- class 2 you’re comfortable at rest, but normal physical activity triggers symptoms
- class 3 you’re comfortable at rest, but minor physical activity triggers symptoms
- class 4 you’re unable to carry out any physical activity without discomfort and may have symptoms even when resting
Knowing the stage of your heart failure will help your doctors decide which treatments they think are best for you.
Page last reviewed: 19 May 2022 Next review due: 19 May 2025
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Role Of Cardiac Rejuvenation Therapy In The Management Of Hf
Current medical management for heart failure only alleviates symptoms, delays deterioration and prolongs life modestly. As the science has progressed by leaps and bounds, the idea of rejuvenation of the failing myocardium has begun to seem feasible when the accumulating evidence from preclinical studies demonstrated that rejuvenating the myocardium at the molecular and cellular level can be achieved by gene therapy and stem cell transplantation .
Stem cells are the population of cells that have self-renewal properties and the potential to generate daughter cells capable of differentiating into specific cell lineages . Stem cells have shown promise to treat several human diseases due to their regenerative properties, and the idea of regeneration of myocardial damage or replacement of lost or damaged myocardial tissue by implanting stem cells has revolutionized the prospects in medicine. As far as heart failure is concerned, stem cells from both autologous and non-autologous sources are seen as feasible and efficient potential therapeutic agents. Several clinical trials using both autologous and allogenic stem cells have proven beneficial to patients of ischemic and non-ischemic heart failure in various clinical trials . Stem cells can be isolated from various sources viz. human-derived myoblast, cardiosphere, mesenchymal, embryonic and menstrual blood.
How Are Blood Tests Performed
Blood tests may be performed in a lab or providers office.1-2 They are a typical part of a routine exam. Sometimes blood tests are done before you eat for the day, after an 8-12 hour fast. Samples of blood are drawn by a needle from a vein in the arm into test tubes which are then analyzed by a lab for the levels of specific components.2
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Autosomal Dominant Arrhythmogenic Right Ventricular Dysplasia/cardiomyopathy
ARVD/C is characterized by progressive fibrofatty replacement of the myocardium that predisposes to ventricular tachycardia and sudden death in young individuals and athletes. It primarily affects the RV with time, it may also involve the LV. The presentation of disease is highly variable even within families, and affected individuals may not meet the established clinical criteria. The mean age at diagnosis is 31 years .
Genetic testing should be considered in individuals who have a clinical diagnosis of ARVD based on the diagnostic criteria. A case can be made to offer genetic testing to all with a clinical diagnosis of ARVD with a negative family history based on the high rate of reduced penetrance thus far identified with the ARVD genes. Molecular genetic testing is available on a clinical basis for TGFB3, RYR2, TMEM43, DSP, PKP2, DSG2, DSC2, and JUP.
For more information regarding genetic testing and cardiomyopathy, please see HFSA Guideline Approach to Medical Evidence for Genetic Evaluation of Cardiomyopathy, as well as Murphy RT, Starling RC. Genetics and cardiomyopathy: where are we now? Cleve Clin J Med. Jun 2005 72:465-6, 469-70, 472-3 passim.