How Heart Failure is Diagnosed (Cleveland Clinic)

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To diagnose heart failure, your doctor will first ask you questions about your symptoms and medical history. Your doctor will want to know:

If you have any other health conditions such as diabetes, kidney disease, angina (chest pain), high blood pressure, high cholesterol, coronary artery disease, or other heart problems
Family history of heart disease or sudden death
If you smoke or use tobacco
If you drink alcohol and how much you drink
If you have been treated with chemotherapy and/or radiation
What medications you are taking
Your doctor will 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 muscle to weaken or stiffen.

Tests performed to diagnose heart failure
Certain tests can help your doctor determine the cause and severity of heart failure. Your doctor will tell you which of these tests you should have:

Blood tests — used 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 hemoglobin (the substance in red blood cells that allows the blood to transport oxygen through the body) in a person’s blood.
B-type Natriuretic Peptide (BNP) blood test — BNP is a substance secreted from the ventricles (lower chambers of the heart) in response to changes in pressure that occur when heart failure develops and worsens. The level of BNP in the blood increases when heart failure symptoms worsen, and decreases when the heart failure condition is stable. The BNP level also indicates if your heart failure condition has worsened and can provide information about your prognosis. In addition, the BNP level helps your health care provider determine if your shortness of breath is due to heart failure.
Cardiac Catheterization — an invasive imaging procedure that involves putting a catheter into a blood vessel in the arm or leg, and guiding it to your heart with the aid of a special x-ray machine. There are two types of cardiac catheterization, left and right. In a left heart catheterization, contrast dye may be injected through the catheter and x-ray movies of your valves, coronary arteries, and heart chambers are taken.Cardiac catheterization is also called coronary angiography. Right heart catheterization does not require contrast dye and is used to measure heart function.
Chest x-ray — shows the size of your heart and whether there is fluid build-up around the heart and lungs.
Echocardiogram (or echo) — a graphic outline of the heart’s movement. During an echo, a probe 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 is often combined with an ultrasound to find changes in the blood flow across the heart's valves and the pressure within the heart’s chambers.
Ejection fraction (EF) — a measurement of the blood pumped out of the heart with each beat. EF can be measured in your doctor’s office during an echocardiogram (echo) or other tests such as a MUGA (multiple gated acquisition) scan, cardiac catheterization, nuclear stress test, or magnetic resonance imaging (MRI) scan of the heart. A normal EF ranges from 60 to 75 percent. 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.
Electrocardiogram (EKG or ECG) — records the electrical impulses in 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.
Multigated Acquisition Scan (MUGA scan) — nuclear scan that evaluates the pumping function of the ventricles.
Stress Test — an exercise stress test is used to provide information about how the heart responds to stress. It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while the electrocardiogram, heart rate, and blood pressure are monitored. When one is not able to do activity, medications may be used to "stress" the heart. This is called a pharmacological stress test.