Diagnosing Cardiomyopathy & Heart Failure

NYU Langone specialists are experts at identifying cardiomyopathy and heart failure, a type of heart disease in which the heart fails to pump enough blood to the body. It can be inherited, or it can be caused by another condition, as well as by certain medications or lifestyle habits.

When cardiomyopathy weakens the heart’s ability to pump blood, heart failure may occur. Right-sided heart failure happens when the heart can’t pump enough blood to the lungs. Left-sided heart failure occurs when the heart can’t pump enough blood to the rest of the body. Most of the time, the condition affects both sides of the heart.

Risk Factors and Symptoms

Risk factors for cardiomyopathy and heart failure include a family history of coronary artery disease, a previous heart attack, excessive alcohol consumption, drug abuse, and obesity. Certain conditions can also increase risk, including high blood pressure, diabetes, thyroid disorders, a buildup of iron in the heart muscle, and sarcoidosis, which causes inflammation in the body’s organs. Cancer treatments, including radiation and certain types of chemotherapy, may also increase a person’s risk.

In its earliest stages, cardiomyopathy and heart failure may not cause noticeable symptoms. However, as the condition progresses, a person may experience fatigue or shortness of breath, especially with physical exertion. They may also have swelling of the legs, feet, and abdomen, which occurs when the body overproduces fluid in response to a reduction in blood pumped from the heart. Other symptoms include heart palpitations or lightheadedness caused by irregular heartbeats, or arrhythmias.

Medical History and Physical Exam

If you are experiencing symptoms, your NYU Langone cardiologist gathers information about your medical history. Your doctor also asks about your family history, because your risk for some types of cardiomyopathy increases if family members have had these conditions.

Next, your doctor conducts a physical exam, in which he or she uses a stethoscope to listen to your heart and lungs for sounds that occur when a person has cardiomyopathy and heart failure. He or she also looks for swelling in your legs and abdomen, which may be due to a buildup of fluid.

Diagnostic Tests

Depending on your symptoms and medical history, your doctor may also perform one or more tests.

Blood Tests

Your doctor may recommend a blood test to check for B-type natriuretic peptide, a protein that the heart secretes to keep blood pressure stable. These levels increase with heart failure. A blood test may also be performed to look for substances that are associated with heart and lung damage.

Other blood tests may include a complete blood count to measure levels of white blood cells, which fight infection; red blood cells, which carry oxygen; and platelets, which help blood clot. The results of a complete blood count test can show if you have anemia, or low levels of red blood cells, which can worsen heart failure.

Doctors also use blood tests to check for underlying conditions, such as diabetes, which can contribute to heart failure.

Chest X-ray

A chest X-ray creates images of the heart and lungs. It can help your doctor detect signs of heart failure, such as changes in the shape or size of the heart or a buildup of fluid in the lungs.

Electrocardiogram

An electrocardiogram (EKG) records the heart’s electrical activity, which controls the heartbeat, to determine the rate, rhythm, and size of the organ. This test can provide clues as to whether the heart is thickened, its chambers are enlarged, or if it’s receiving enough blood and oxygen.

During an EKG, small, painless metal electrodes are affixed to the chest, wrists, and ankles. They send information about your heart to a machine, which prints out a graph of the heart’s electrical activity.

Transthoracic Echocardiogram

A transthoracic echocardiogram is an ultrasound test that uses sound waves to produce detailed images of the heart, enabling your doctor to evaluate the heart’s ability to pump blood—called its ejection fraction—and to identify any abnormalities in the size or shape of the heart.

During this test, a technician uses a handheld device called a transducer, which is placed on your chest. It sends images of your heart to a computer.

Coronary Catheterization and Angiogram

In coronary catheterization and angiogram, your doctor uses X-ray images taken in real time to create cross-sectional images of the heart. This enables the doctor to determine how well the heart is pumping blood to the rest of the body and to view any blockages in the blood vessels.

After you are given local anesthesia and a sedative, your doctor guides a small, hollow tube called a catheter into a puncture in a vein in the arm or groin. He or she advances it through the aorta, the body’s largest artery, to the heart.

An X-ray instrument called a fluoroscope is inserted into the catheter and led to the heart to provide live X-rays of the heart’s chambers. Your doctor also injects a contrast agent into the catheter to highlight any blockages.

MRI Scans

MRI uses a magnetic field and radio waves to produce computerized, three-dimensional pictures of the heart to assess the organ’s structure and function. An MRI scan can help identify whether heart tissue is scarred, which occurs as a result of some types of cardiomyopathy.

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