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To determine whether you have heart failure, your health care team might perform some or all of these diagnostic tests and procedures. Always tell your health care professional about any health problems, recent surgeries or allergies you might have — and whether you are pregnant — before undergoing any kind of test or examination.

Different facilities and exams have different guidelines about eating and drinking beforehand. Eat food, drink fluids and take your medications as usual unless your health care professional tells you otherwise.

Physical examination

The physical exam for heart failure is largely painless. Here is how your exam will go:

• Your health care team will ask you about your medical history, list of medications and symptoms. Typically, you fill out forms with this information before your examination. Your health care professional could ask you the questions again during the exam, too.
• A health care professional will take your blood pressure and weigh you.
• Your health care professional will listen to your heart and lungs using a stethoscope. They will also look for any swelling in your feet and ankles, as well as in your abdomen, and assess your cognitive state.

Tips for success:

• Your health care professional can't make an accurate diagnosis without your full input. Think of your health care professionals as your partners. You have to work together to be successful.
• Don't be afraid to "look bad." For instance, if you smoke, eat foods with a lot of fat in them or are physically inactive, be honest. That information helps determine your risk for heart failure.
• Follow all instructions in preparation for your exam. You could be told not to eat or drink anything for a certain amount of time before your appointment.
• Take all your medications, or a list of all your medications, to your appointment. That includes over-the-counter drugs, vitamins and supplements as well as prescriptions. 

Blood tests

How blood tests are performed:

• Either in your health care professional's office or in a lab, a health care professional will draw a sample of blood from your arm. 
• They will send the sample to a lab to get analyzed for levels of important substances, such as sodium and potassium (sometimes called electrolytes), albumin (a type of protein), creatinine (which is connected with kidney function) and certain other tests which can help diagnose heart failure and predict outcomes.

What blood tests show:

Abnormal results could indicate a strain on the heart or on other organs such as the kidneys and liver, which often results from heart failure. 

Chest X-rays

Chest X-rays are painless. They could be taken in the health care professional’s office or in a separate radiology lab. Further imaging tests will likely be needed after a chest X-ray. These images are an initial imaging step in diagnosing heart failure and cannot capture all the details needed for a formal diagnosis.

Here's how chest X-rays are performed: 

• Remove any metal, including jewelry, removable dental appliances and your glasses, before the X-rays are taken. Wear loose-fitting clothing to be more comfortable. And if you have any medical devices, or if you might be pregnant, be sure to tell your health care professional before the X-ray testing begins.
• X-rays are taken while you stand up or lie down on a table. Your technician will cover parts of your body they want to protect from the radiation used to take X-ray images. You could be asked to wear a gown.
• A technician will use the X-ray machine to take pictures of your heart, called radiographs. The process only takes a few minutes, but can take longer if you have trouble sitting still.
• X-ray images, called radiographs, can be taken from the back, front and/or the sides to give your health care professional a full view of your heart from every angle.

What X-rays reveal:

• Whether the heart is enlarged
• Whether there is congestion in the lungs
• Whether something other than heart failure is responsible for your symptoms

Learn more about chest X-rays.

Electrocardiogram (EKG or ECG)

Electrocardiograms are painless. They capture your heart’s electrical activity. Here's how an EKG is performed:

• You will lie still on a table while a health care professional places small electrodes (round plastic discs the size of a half dollar) on your chest.
• Wires run from the electrodes to the EKG machine, carrying recordings of your heart's rhythm, frequency of beats and electrical conduction.

An EKG reveals:

• Whether you've had a heart attack
• If the left ventricle is thickened (enlarged heart muscle wall)
• If the heart rhythm is abnormal (noting any arrhythmias such as atrial fibrillation, or AFib)
• The strength and timing of your heartbeat 

Learn more about an electrocardiogram.

Echocardiography (abbreviated as "echo")

An echocardiogram is a generally painless imaging procedure that uses sound waves to examine the heart's structure and motion. How echocardiography is performed: 

• You might need to be sedated, depending on what type of echo you are having done. 
• You will lie, either on your back or left side, on an exam table while a technician moves a device over your chest. You might be given a gown to wear.
• The device in the technician’s hand gives off a silent sound wave that bounces off your heart, creating images of the chambers and valves.

An echocardiogram reveals:

• How thick the heart muscle is.
• How well the heart pumps.
• The size and shape of your heart.
• Your heart's ejection fraction.
• The condition and function of your 4 heart valves (tricuspid, pulmonic, mitral, aortic)

Learn more about echocardiography.

Exercise stress test

An exercise stress test measures how well your heart functions when your body is active. The test is painless but could feel strenuous. It takes about 15 minutes. How a stress test is performed: 

• You will be connected to a heart monitor. This will include an electrocardiogram to measure electrical activity in your heart and your heart rate, as well as a blood pressure monitor.
• Sometimes, it might include an imaging test like an echocardiogram, cardiac MRI or a nuclear heart scan during or after the test.
• You might wear a mask or mouthpiece that measures how your body uses oxygen when you are active.
• You will walk slowly in place on a treadmill or pedal slowly on a stationary bike. Then your care team might increase the treadmill's speed and the treadmill’s angle to produce the effect of going up a small hill.
• Your care team will monitor your heart rate and rhythm, breathing and blood pressure, and how tired you feel during the test.
• Your care team will ask you to keep up the pace for as long as you can, but you can stop the test at any time, if needed. Your care team will also stop the test if you start to show signs of a heart problem or if you are too tired to continue. 
• Afterward, you will sit or lie down while your care team checks your heart and blood pressure.

If you cannot exercise, your care team will give you medicine to elevate your heart rate to mimic how it would behave during exercise. They will deliver this medication through an intravenous (IV) line. This version of the test takes about 10–20 minutes.

An exercise stress test reveals:

• How your heart responds to exercise.
• Whether the blood supply is reduced in the arteries that supply your heart.
• The kind and level of exercise that's appropriate for you.
• What treatment plan would likely work best for you.

Learn more about exercise stress test.

Radionuclide ventriculography or multiple-gated acquisition scanning (abbreviated as MUGA)

MUGA scans take multiple pictures of your heart at different points in time to create a film of multiple cardiac cycles. The test is a painless procedure, outside of a shot or an IV (an intravenous drip line) at the beginning. There's no lasting effect from the radionuclides used in the test.

This test is particularly beneficial for people at risk for experiencing heart failure due to being treated for cancer with chemotherapy drugs. Repeating the test allows your health care team to get a better understanding of your heart’s function before, during and after chemotherapy.

How the procedure is done:

• Radioactive substances called radionuclides are injected into the bloodstream. These substances will attach to your red blood cells, showing them as they move through your body.
• Computer-generated pictures display the locations of the radionuclides in the heart.

A MUGA scan reveals:

• An enhanced view of the structure and dynamics in your heart.
• How well the heart muscle is supplied with blood.
• How well the heart's chambers are working.
• Whether part of the heart has been damaged by heart attack.
• How your blood moves through your heart.
• How well your heart functions at rest and while under stress.

Learn more about a MUGA scan.

Cardiac catheterization

Cardiac catheterization is a procedure that evaluates blood flow through the coronary (heart) arteries. How the procedure is done:

• Your care team will insert a very small wire (catheter) into a blood vessel in your upper thigh or arm. The catheter might have a tiny camera on the end of it to help provide your health care professional with images of your heart. Your care team can also use it to gather samples of your blood or heart muscle.
• Your care team will feed the tip of the wire from the entry point in your body either to the heart or to where the arteries supplying the heart originate.
• Your care team will inject a special fluid (called a contrast medium or dye) that helps make your heart visible. Your health care professional might also use ultrasound during the procedure to get more images.
• The pictures your care team takes during this procedure are called angiograms.
• This procedure could involve some discomfort from the placement of the catheter. You could be required to rest in a certain position after the procedure.

A cardiac catheterization reveals:

• Blockages in the coronary arteries.
• Whether the parts of your heart that are fed by the blocked or narrowed arteries are weakened or damaged from lack of blood.
• The oxygen levels and blood pressure in your heart chambers and pulmonary arteries.

Learn more about cardiac catheterization.

Magnetic resonance imaging (MRI)

Cardiac magnetic resonance imaging produces detailed pictures of the structures within and around your heart using a powerful magnetic field, radio waves and a computer. The test is painless and does not use any radiation and the magnetic field is not harmful. However, the test could interfere with some medical devices, so always make sure you go over what medical devices you have with your care team before undergoing a cardiac MRI. Ask your health care professional about options for taking a mild sedative prior to the test if you have claustrophobia or anxiety.

How an MRI is performed:

A radiologist or MRI technologist usually performs the scan in a hospital, clinic or imaging center using special equipment. 

• You will lie down on a movable table that slides into the MRI machine. Your care team might use straps and bolsters to help you lie still and stay as comfortable as possible. The machine looks like a long metal tube.
• Your technologist will watch you from another room. You can talk with them by microphone. In some cases, a friend or family member may stay in the room with you.
• Your care team might attach electrodes to your chest to help them synchronize the images they take with your heartbeats.
• The MRI machine will create a strong magnetic field around you, and radio waves will be directed at the area of your body to be imaged. You won't feel the magnetic field or radio waves. 
• During the MRI scan, the magnet produces loud tapping or thumping sounds and other noises. You might be given earplugs or headphones to listen to music to help block the noise. Your care team could also do multiple runs (sequences) of the test. Some runs can last several minutes, and each one will create different noises.
• In some cases, such as for an MRA (magnetic resonance angiography), you might have an intravenous (IV) line in your hand or arm for injecting a contrast agent into your veins. The contrast agent produces detailed images of your tissues and blood vessels. 
• An MRI scan lasts between 30 and 90 minutes.

An MRI reveals:

• An MRI can show your heart's structure (muscle, valves and chambers) as well as how well blood flows through your heart and major vessels.
• An MRI of the heart lets your health care professional see if your heart is damaged from a heart attack or if there is lack of blood flow to the heart muscle because of narrowed or blocked arteries.

Learn more about MRI.