In this article, we will discuss Diagnosis of Heart Failure. So, let’s get started.
Investigations
These are done to establish the nature and severity of the disease and to detect complications.
- Electrocardiogram: It will reveal ventricular hypertrophy arrhythmias and myocardial ischemia/infarction.
- Chest X-ray will show enlargement of heart, peripheral lung congestion, presence of Kerley’s line, pulmonary edema, hydrothorax, pulmonary hypertension, double atrial shadow in mitral valve disease and calcification of valves.
- Two-dimensional doppler echocardiography is useful to detect unsuspected valvular lesion, assessing the chamber dimensions and ejection fraction (EF), left atrial myxoma and a thrombus or aneurysm or pericardial effusion. Cardiac MRI is now the gold standard for assessing LV mass and volumes as well as for determining the cause of heart failure (amyloidosis, cardiomyopathies, harmachesomatosis).
- Blood urea, creatinine and electrolytes for renal failure and electrolyte disturbance.
- Biomarkers: The circulating levels of brain natriuretic peptide (BNP) are elevated in CHF and it guides therapy in heart failure. A normal level of natriuretic peptide in untreated patients exclude the diagnosis of CHF hence, it differentiates dyspnea due to heart failure from non-cardiac causes. Other biomarkers, e.g. troponins (T and I), C-reactive protein, uric acid are also elevated. The newer biomarkers are soluble ST2 and galactin-3.
- Cardiac catheterization: Left heart catheterization may be useful to define the presence or extent of CAD. Coronary angiography can also be performed. Right ventricular catheterization is done to monitor the therapy in refractory heart failure.