How Do You Check for Congestive Heart Failure?

Last Editorial Review: 9/27/2017

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How do you check for congestive heart failure?

Doctor's response

Diagnosis of congestive heart failure is able to be accomplished by history and physical examination. The health care professional often will ask question about the symptoms like shortness of breath, swelling in the legs, chest pain, and what the patient does to make them better (sit down, rest). It will also be important to know whether the symptoms have come on gradually or over a shorter period of time.

Past medical history, medication history, diet, and social history including alcohol and drug use are all important to share. Should congestive heart failure be thought to be caused by atherosclerotic heart disease, risk factors for heart disease may be explored.

Physical examination begins with observing the patient to decide how comfortable they are at rest and whether the walk to the exam area made them short of breath. Vital signs including blood pressure, pulse rate, respiratory rate, oxygen saturation, and body weight may be helpful to assess how ill the patient might be. The exam often concentrates on the heart and lungs.

When examining the lungs, the health-care professional determines if there is good air entry in both sides of the chest or if there are extra sounds that might be heard when fluid is present. Tapping on the chest (percussion) can uncover a fluid buildup.

Heart exam includes feeling for the apex beat, the heart beat that can be felt through the chest wall. If it is displaced in the direction of the armpit, it may be a sign that the heart is enlarged. Listening to the heart sounds may uncover abnormal beats called gallops that are heard in heart failure. Murmurs may help diagnose heart valve disease. Rubs are noises made when the pericardium or fibrous sac covering the heart has become inflamed or enlarged.

The neck may be examined looking for jugular venous distention. The jugular veins will dilate if there is extra fluid in the body and may be a sign of right heart failure. Peripheral edema (tissue swelling) is also found in right heart failure. The doctor will often look at the feet and ankles first to see if they are swollen. The abdominal examination may reveal an enlarged liver or ascites (fluid accumulation in the abdominal cavity).

For more information, read our full medical article on congestive heart failure signs, symptoms, and treatment.

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