Women and men should receive the same testing to diagnose heart failure and exclude other causes for their symptoms of heart failure.
The diagnosis for heart failure may include:
Medical History and Physical Exam
To diagnose heart failure, your doctor will first ask you questions about your symptoms and medical history. While diagnosing heart failure, your doctor will want to know:
- If you have any other health conditions such as diabetes, kidney disease, angina, high blood pressure or other heart problems
- If you smoke
- If you drink alcohol and how much you drink
- What medications you are taking
- Your doctor will also perform a complete physical exam. Your doctor will look for signs of heart failure as well as any other illnesses that may have caused your heart to weaken.
Blood Tests:
Certain blood tests can help your doctor determine the cause and severity of heart failure. Blood tests may be done to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia. Anemia is a blood disorder that occurs when there is not enough red blood cells in a person's blood.
B-type Natriuretic Peptide (BNP) blood test
When heart failure occurs or worsens, the pumping chambers, or ventricles, secrete a substance called BNP (pro-B type natriuretic peptide) in response to the accompanying changes in blood pressure. The BNP level rises when heart failure symptoms worsen, and it falls when the condition is stable. BNP helps determine if you have heart failure, rather than another condition that may cause similar symptoms. It also can help the doctor determine if your heart failure has worsened and more aggressive treatments are needed.
To test the BNP level, a small amount of blood is taken and placed in a machine that detects the level of BNP in your blood. The BNP level helps determine if you have heart failure. Usually, BNP levels below 100 pg/mL indicate no heart failure and levels above 100-300 suggest heart failure is present.
The BNP level also indicates if your heart failure condition has worsened and can provide information about your prognosis.
It shows the size of your heart and whether there is fluid build-up around the heart and lungs.
It is a graphic outline of the heart's movement. During an echo, a wand is placed on the surface of your chest. This wand sends ultrasound waves that provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied. Echo can also find changes in the blood flow across the heart's valves and the pressure within the heart's chambers. It may also help estimate the blood pressure within the lungs.
Records the electrical impulses traveling through the heart. During the test, small, flat, sticky patches called electrodes are placed on your chest. The electrodes are attached to an electrocardiograph monitor (EKG) that charts your heart's electrical activity on graph paper.
Ejection fraction (EF)
A test that determines how well your heart pumps with each beat. A normal EF is generally 50-55%. It is important for your doctor to know your EF. Your EF can go up and down, based on your heart condition and the effectiveness of the therapies that have been prescribed. It is important to have your EF measured initially and as needed, based on changes in your condition. Ask your doctor how often you should have your EF checked.
An EF of less than 50 percent usually confirms a diagnosis of systolic heart failure (a condition that occurs when the heart muscle doesn't contract with enough force, so there is not enough oxygen-rich blood to be pumped throughout the body). Diastolic dysfunction is a condition that occurs when the heart contracts normally, but the ventricle doesn't relax properly so less blood can enter the heart. People with diastolic dysfunction can have a normal EF or a low EF.
Other tests
Tests such as cardiac catheterization or stress tests , may be ordered by your doctor, depending on your condition.
Test Results
Although the same tests are used to diagnose heart failure in women and men, the results may not be the same. For instance, BNP blood levels are used to help diagnose heart failure and determine severity. However, the "normal" values for women are higher than for men 1-3.
There is also some evidence to suggest that the results of a metabolic stress test (which evaluates oxygen uptake during exercise - Peak VO2) 4-5 are worse for women than men. The differences in results may be related to the adjustments made to the test results. The metabolic stress test results are adjusted for body weight but are not adjusted for lean body mass. This may explain the differences in results among men and women, since women usually have a higher percentage of body fat than men.
- Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC Jr.Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardiol. 2002 Sep 4;40(5):976-82.
- Alan H.B. Wu, Milton Packer, Andrew Smith, Rachel Bijou, Daniel Fink, Johannes Mair, Lars Wallentin, Nina Johnston, Carolyn S. Feldcamp, Doris M. Haverstick, Charaf E. Ahnadi, Andrew Grant, Normand Despres, Barry Bluestein, and Farooq Ghan. Analytical and Clinical Evaluation of the Bayer ADVIA Centaur Automated B-Type Natriuretic Peptide Assay in Patients with Heart Failure: A Multisite Study. Clin. Chem. 2004; 50: 867-873.
- Wang TJ, Larson MG, Levy D, Leip EP, Benjamin EJ, Wilson PW, Sutherland P, Omland T, Vasan RS. Impact of age and sex on plasma natriuretic peptide levels in healthy adults. Am J Cardiol. 2002 Aug 1;90(3):254-8.
- Richards DR, Mehra MR, Ventura HO, Lavie CJ, Smart FW, Stapleton DD, Milani RV. Usefulness of peak oxygen consumption in predicting outcome of heart failure in women versus men. Am J Cardiol. 1997 Nov 1;80(9):1236-8.
- Daida H, Allison TG, Johnson BD, Squires RW, Gau GT. Comparison of peak exercise oxygen uptake in men versus women in chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1997 Jul 1;80(1):85-8. *
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written with Dr. Eileen Hsich, specialist in Women & Heart Failure