The first step your doctor will take to assess whether you have congestive heart failure (CHF) is to discuss your medical history and conduct a complete physical exam.

During the physical exam, your doctor will look for some of the characteristic signs of CHF, such as:

• Sound of fluid in the lungs
• Enlargement of the jugular vein in the neck
• Enlargement of the liver
• High blood pressure or low blood pressure
• Fast heart rate ( tachycardia)
• Swelling of the ankles, legs, feet (edema)
• Fluid in the abdominal cavity ( ascites)
• Fluid in the space between the lungs and ribs ( pleural effusion)

Afterwards the physical exam, your doctor may recommend tests to help make the diagnosis and assess the degree of damage. Examples of these tests include:

• Chest x-ray —An x-ray image will show whether the heart is enlarged or whether congestion is present in the lungs.
• Blood tests—The doctor will check for many conditions, such as anemia, thyroid disorders, and high cholesterol. In addition, your doctor will evaluate the functioning of your kidneys and liver and check the brain natriuretic peptide (BNP) level in your blood. The BNP level is used as an indicator for heart failure.
• Electrocardiogram (EKG or ECG) —The EKG records the electrical activity of your heart through electrodes attached to the skin. This test will help diagnose heart rhythm problems, muscle abnormalities, and damage to the heart from a heart attack.
• Echocardiogram —This test uses sound waves to produce an image of the working heart. This test helps evaluate the function of the heart's valves and chambers and determines the amount of blood ejected from the heart with each heartbeat. An echocardiogram also can detect structural damage, tumors, or excess fluid around the heart.
• Exercise stress test —This test records the heart's electrical activity during increased physical activity. It may be coupled with an echocardiogram or myocardial perfusion imaging. Patients who cannot exercise may be given medicine intravenously (through a vein in the arm) that simulates the effects of physical exertion.
• Myocardial perfusion imaging —During this test, radioactive material is injected into a vein and observed as it is absorbed by the heart muscle. Areas with diminished flow show up as dark spots on the scan.
• Coronary angiography and coronary catheterization —Contrast dye is injected via a thin, flexible tube (catheter) that is threaded into the aorta or heart. X-rays are then taken to view blood flow and highlight the arterial blood vessels. This test helps to detect obstruction in the arteries and assess heart function. Testing to check for blockage in the coronary arteries is recommended for some individuals with heart failure, especially younger patients and patients with symptoms of chest pain and angina.
• CT angiography and electron-beam CT scan —These tests are used to find blockages in the arteries. With CT angiography, a small amount of dye is injected into the blood vessels. As the dye passes through the heart, a very strong x-ray machine helps to show blood flow blockages. Electron-beam CT scan uses an electron "gun" instead of an x-ray machine to scan the chest.
• Cardiac MRI scan —This test uses high intensity magnetic fields to generate high resolution images. It can help evaluate large blood vessels, coronary arteries, heart walls, and pericardium (double-walled sac that contains the heart).