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It can be difficult for doctors to be sure if someone has heart failure, especially people who are elderly or overweight. This is because the symptoms of heart failure are similar to the symptoms of many other illnesses.

Your doctor will probably start by talking to you about your symptoms. You may be asked how long you've had symptoms and how much they affect your life. Your doctor will probably want to know if you feel short of breath when you are sitting still and whether you have pain in your chest when you walk up a flight of stairs.¹

Your doctor will listen to your heart and lungs, and you will need to have some blood tests.¹ You will need to go to the hospital for some of your tests.

This is the best test for diagnosing heart failure.¹ It's sometimes called an "echo" for short. It is an ultrasound of your heart. A doctor or a trained technician puts some gel on your chest and then puts an ultrasound probe on your chest, with the gel underneath the probe to make it more comfortable. By moving the probe over your chest, it takes pictures of your heart as it pumps blood. The doctor can then look at the ultrasound of your heart to see if it is pumping normally or not. An echo can also tell the doctor about the size and shape of your heart, whether it has been damaged by a heart attack, and whether or not your heart valves work properly. The doctor can check how well it's pumping blood.

BNP stands for B-type natriuretic peptide. It's a hormone made by your heart. If the amount of BNP in your blood in higher than normal, it's a sign that you could have heart failure.² Doctors also use this test to see how bad your heart failure is.

If your BNP is very low, you can be pretty sure that you don't have heart failure and don't need further tests.³

You might be given an MRI scan or a CT scan of your heart.¹ This helps doctors check the size of your heart and the different chambers inside it. A bigger heart than normal usually means that it has to work harder to pump blood around the body and that you have heart failure.

An electrocardiogram is often called an ECG or EKG for short. It measures the electrical activity in your heart and can help doctors figure out if you may have had heart damage in the past. Sometimes an ECG will show that your heart is enlarged. This is a common finding in someone with heart failure. This test helps your doctor work out whether your have heart failure and what may be causing it.¹

If your ECG shows something is wrong, your doctor will do extra tests to find out more. If your ECG is normal, you may still have heart failure so you should have further tests to check that you don't have heart failure.²

Your doctor will probably use a scoring system to rate your symptoms. To learn more, see How heart failure is classified.

Your doctor may ask you questions from a test that has been designed to help doctors find out how much heart failure affects their patients. If you want to read a version of this test, see the Quality-of-life test. Your doctor may also measure how far you can walk in six minutes. To find out about this test, see the Six-minute walk test.

You may have blood tests to see how well your liver and kidneys are working and to test whether you have diabetes or high cholesterol.

You may also have a chest X-ray.¹ This takes a picture of your lungs and is used to check whether something other than heart failure is causing your symptoms.

And you may be asked to blow into a peak flow meter or a spirometer to check for lung disease.

The results of your tests will help your doctor be certain that your symptoms are caused by heart failure, not another illness. Your doctor may refer you to a specialist, especially if you have other illnesses or you are pregnant.²

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.