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Heart Disease - Diagnosing Congestive Heart Failure (CHF)

Because congestive heart failure (CHF) typically results from other cardiac diseases, most commonly coronary artery disease, asymptomatic patients are not usually screened for CHF. When patients present symptoms that may indicate CHF, diagnostic tests will be performed to determine the cause. In some cases, results from coronary artery disease screening methods (blood cholesterol tests, blood pressure measurements, stress tests, etc.) may also indicate CHF and warrant further examination.

Early symptoms of CHF may include:

  • Fatigue
  • Dyspnea (shortness of breath)
  • Wheezing or hoarseness

Other noticeable symptoms include:

  • Heart palpitations
  • Swollen ankles and legs
  • Weight gain (due to fluid build-up)

Depending on the extent of CHF, patients may also have other complications including:

  • an abnormal heart murmur
  • pulmonary congestion
  • arrhythmia (irregular heartbeat)
  • hypertrophy (enlarged heart)
  • tachycardia (accelerated heartbeat)
  • kidney or liver problems

Diagnosing CHF typically begins with a physical exam, including careful documentation of the patient’s medical and personal history of heart problems (i.e., atherosclerosis—narrowing of arteries, coronary artery disease, history of CHF, congenital heart disease).

To help diagnose heart failure and gauge treatment, the New York Heart Association (NYHA) functional classification system or similar criteria may be used:

Class Description
Class I (Mild) No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).
Class II (Mild) Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
Class III (Moderate) Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class IV (Severe) Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased