Heart Failure: Diagnosis and Treatment

Diagnosis

• The evaluation begins with a medical history and a physical examination.
• The New York Heart Association classification system describes the stages of heart failure:
  
• Class I: Symptoms (e.g., fatigue, shortness of breath, and palpitations) are experienced only with heavy exertion.
• Class II: Symptoms occur with mild to moderate levels of exertion.
• Class III: Symptoms occur with less-than-ordinary exertion.
• Class IV: Symptoms occur at rest.
• An electrocardiogram (EKG) is an important tool for diagnosing heart damage and arrhythmias.
• A chest X-ray can identify many heart and lung diseases. It is especially useful to check for fluid in the lungs, which is common in heart failure.
• An echocardiogram can evaluate the left and right chambers of the heart, the heart valves, and heart function.
• Blood testing is sometimes recommended.

Treatment

Treatment of heart failure should target the underlying disorder: hypertension, coronary artery disease, diabetes, etc. See relevant chapters for specific information.

• Exercise conditioning, which should be approved by a physician and overseen by an exercise physiologist, can be helpful.
• Leg elevation above the heart should be done during rest.
• Compression stockings may help control leg swelling.
• Diuretics, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors are the first-line therapies for most heart failure patients.
• Other medications that are commonly used include aldosterone blockers (e.g., spironolactone), calcium channel blockers (e.g., verapamil and diltiazem), anticoagulants (e.g., warfarin), and digoxin.
• In advanced cases, surgical procedures may be warranted. Some patients at risk for arrhythmias may benefit from an implantable cardioverter-defibrillator. Others may benefit from a heart transplant.

Prevention and treatment of heart failure also require lifestyle modifications, as described in Nutritional Considerations.