Download Testing in Heart Failure

Testing In Heart Failure
Answers, Answers, Answers…
Shashank Desai, MD
Medical Director, Heart Failure / Transplant Program
Inova Fairfax Hospital
Falls Church, VA
Purpose of Testing
• Diagnosis – Why?
• Prognosis – How Bad?
• Therapeutics – What Next?
Echocardiogram
Ultrasound of the heart
size and shape of the heart
squeezing function of the heart
relaxing function of the heart
valve functioning
Limited ability
Coronary artery blockage
Prognosis
Other Imaging
Cardiac MRI
Nuclear Stress Testing and Coronary
Angiography (left heart catheterization)
• Used to see if there is
coronary artery disease
as a cause
• Needed to determine if
angioplasty or bypass
surgery is helpful
• Limited in the ability to
determine prognosis in
heart failure
Cardiopulmonary Exercise Testing /
Exercise VO2 test
• Ability to evaluate the heart’s peak capacity
• Either with treadmill or bicycle
• Uses the oxygen used and carbon dioxide
produced to assess the heart’s ability to perform
• Very useful in determining short term prognosis
• Prognosis similar to other exercise testing – six
minute walk test or regular treadmill
Right Heart Catheterization /
Hemodynamics
• Used to assess the filling pressures and
the heart output directly
• It can differentiate the reason for the
heart failure to occur
• Hollow tube passed via a vein – neck,
shoulder, arm, or groin
• Other end has a balloon at the tip
• This floats through the right chambers of
the heart into the lung artery
• Useful in diagnosis, prognosis, and
therapeutics
Blood Testing
• Determine how good the other organs are
functioning
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Sodium (Na)
BUN
Creatinine (Cr)
Liver function tests
• Stress inside the heart
• BNP
• NT pro-BNP
Blood Testing
• Scar inside the heart
• Galectin 3
• Diagnostic blood tests
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Thyroid Functions
Iron studies
HIV
Hepatitis B and C
Heart Biopsy
• Routine use in
evaluation of heart
failure is not done
• Only in cases of certain
possible diseases that
invade the heart and
therapies would be
different
At the time of diagnosis
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Echocardiogram
Blood testing
Stress test or coronary angiography
Maybe:
– exercise testing
– right heart catheterization
– heart biopsy
Following heart failure over time
• Echocardiogram annually
• Blood Testing routinely – often every 3 months
• Coronary angiography / Stress testing if coronary
artery disease present and if new chest pains or if
worsening situation
• Exercise testing – baseline and regularly over
time - annually. This is based on the severity and
degree of concern
• Right heart catheterization – baseline and usually
when things are not going well. Routinely
depending on severity
Questions?