Diagnosis of Congestive Heart Failure

Congestive heart failure (CHF) is a condition that results in the heart being unable to sufficiently pump enough oxygen-rich blood to the rest of the body. As blood flow out of the heart slows, blood backs up into the body’s other organs, causing congestion in the tissues. CHF is primarily diagnosed using the knowledge of the patient's medical history, blood and laboratory tests, and a thorough physical examination.

Causes

• Conditions such as high blood pressure, coronary artery disease, heart attack, arrhythmia (abnormal heart rhythms) and cardiomyopathy (disease of the heart muscle) most commonly cause congestive heart failure. While not always fully reversible, the condition can be treated and managed with the appropriate medications and lifestyle modifications.

Symptoms

• The most common symptoms of CHF include shortness of breath while active and lying down, swelling of the abdomen, ankles, and legs, rapid or irregular heartbeat and extreme fatigue.

  Patients may also suffer from nausea, rapid weight gain due to fluid retention, coughing, trouble sleeping and loss of appetite.

Physical Exam

• The physical exam primarily determines whether the body is storing excess salt and water in the body. This fluid retention is known as edema, and is a common symptom in heart failure patients. Doctors also determine the condition of the heart by checking the patient’s vital signs such as pulse, blood pressure, heart size, heart sounds and breath sounds.

Diagnostic Tests

• An electrocardiogram (ECG) is used to detect any potential arrhythmia.

  Chest X-rays indicate any enlargement of the heart, as well as any potential fluid buildup in or surrounding the lungs.

  An echocardiogram, an detailed ultrasound of the heart, is used to view and measure images of the heart muscle, any valve abnormalities and patterns of blood flow. This test is also used to measure the patient’s ejection fraction (EF). Your EF is the percentage of oxygen-rich blood that is being pumped out of your heart to the rest of the body. Generally, CHF patients produce an EF lower than 50%

  An angiogram determines the presence of coronary artery disease, a narrowing or clogging of the arteries due to plaque build up.

  A common blood test used to indicate the presence of CHF is a brain natriuretic peptide level (BNP). Your BNP level can vary with age and sex, but is generally at higher levels in the presence of heart failure.

Treatments

• CHF can be treated through a combination of medicines such as ACE inhibitors and beta blockers. ACE inhibitors relax your blood vessels, improving circulation and lowering blood pressure. Beta blockers slow the heart rate and also lower blood pressure. Both drugs improve heart function and quality of life in CHF patients. Digitalis is a drug used to strengthen the heart muscle and improve its pumping action, while diuretics remove excess salt and water from the body. They are used to relieve edema and cause patients to urinate frequently.

  Battery-powered medical devices such as implantable cardioverter defibrillators (ICD's) and pacemakers are implanted under the skin in some patients to help the heart beat in a coordinated fashion. Both ICDs and pacemakers are electrical impulse generators designed to provide therapy to the heart when necessary. ICDs shock the heart back into a normal rhythm in the presence of an arrhythmia, while pacemakers monitor and pace the heart to consistently beat in a normal rhythm.

  Heart transplants are performed on acute CHF patients whose hearts can no longer adequately function. The heart is replaced with a donor's healthy heart.

  Coronary bypass surgery is performed on CHF patients suffering from coronary artery disease. Doctors bypass blood around the clogged arteries, thereby promoting better blood flow to the heart.