1. History and Physical 

Heart failure diagnosis is a two part process. The first part is to determine if the symptoms are heart failure and not some other condition. The second part is to determine the cause of the heart failure, if in fact it is heart failure.

Both of these parts of diagnosis are approached simultaneously by sequentially following a series of testing steps.

The first step of all medical detective work is always a good history and physical. This is where the patient is questioned about their symptoms, signs they’ve noticed and any medical problems or risk factors they have. 

Common Signs and Symptoms

  • Dyspnea (shortness of breath)
  • Leg edema (swelling)
  • Abdominal swelling and bloating
  • Exercise intolerance
  • Fatigue
  • Orthopnea (hard breathing lying down)
  • Paroxysmal nocturnal dyspnea (waking up breathless)
  • Excessive weight gain


2. Initial Blood Work

Several tubes of blood will be drawn to assess the status of the major organs of the body for both disease and the effects of heart failure.

Key Lab Tests

  • B-type natriuretic peptide level
  • Troponin
  • Complete metabolic profile
  • Calcium level
  • Magnesium level
  • Complete blood count
  • Liver function tests
  • Renal function tests
  • Serum electrolytes
  • Thyroid-stimulating hormone level
  • Urinalysis

3. Second Battery of Tests

Generally the first batch of tests gives all the information that’s needed to make a diagnosis or at least to rule out some things. Occasionally, depending on the history, physical exam, or results of initial battery of tests, a second battery of more specific and specialized tests may be ordered.

Some typical specialized tests may include:

  • Arterial blood gases
  • Blood cultures
  • Viral serologies
  • Human immunodeficiency virus
  • Lyme serology
  • Serum ferritin level
  • Transferrin saturation
  • Thiamine level


4. Imaging Studies 

To assess the status of the heart itself a few imaging tests are done on almost all patients presenting with heart failure. An echocardiogram is the most important test and gives the most information. An electrocardiogram (EKG) and chest x-ray are also done on most patients. 

5. Additional Imaging Studies

Results of earlier tests may point to a diagnosis that requires more specialized testing to confirm or rule out.  Additional imaging tests may include:  

  • Exercise stress test
  • Cardiac catheterization
  • Chest CT angiography
  • Multiple-gated acquisition (MUGA) scan
  • Cardiac Magnetic resonance imaging (cMRI)