Diagnostic testing for heart failure includes chest X-ray, ECG, echocardiography, and pulmonary artery catheterization.In a patient with heart failure, a chest X-ray reveals an enlarged heart, indicating hypertrophy or dilation. If the patient is in the early stages of heart failure, the chest X-ray may show congested pulmonary veins in the upper lobes. If he is in the late stages, the X-ray may show interstitial pulmonary edema and pulmonary effusion. If the patient has biventricular failure, the chest X-ray may show a pleural effusion.
A physician uses an ECG to detect left ventricular hypertrophy. An ECG also detects signs of arrhythmias, such as irregular QRS complexes and F waves, and signs of myocardial ischemia, such as T-wave inversion and ST-segment elevation.
Used to measure the size of the heart chambers, echocardiography may reveal an enlarged right or left atrium. This test also is used to assess ventricular function and to detect ventricular hypertrophy. With normal ventricular function, echocardiography shows concentric contractility, a lack of abnormal wall movement, and a left ventricular ejection fraction of 55% to 60%. With left ventricular hypertrophy, it displays a ventricular wall thickness that exceeds 1.2 cm during diastole.
Pulmonary artery catheters are used to measure cardiac pressures. In right ventricular heart failure, the patient’s right atrial pressure may be elevated. In left ventricular heart failure, his pulmonary artery pressure and pulmonary artery wedge pressure are elevated, and CO is reduced.