Fast Five Quiz: Heart Failure Presentation and Diagnosis

Yasmine S. Ali, MD


December 02, 2021

Figure 2. Example of transthoracic echocardiography (TTE) with doppler.

Transthoracic echocardiography (TTE) with Doppler is the recommended imaging study for the initial evaluation of patients with known or suspected heart failure. This modality permits evaluation of ventricular function and accurate assessment of primary and secondary valvular abnormalities.

TTE is also important in distinguishing diastolic heart failure (preserved EF) from systolic heart failure (decreased EF) and measuring pulmonary artery and ventricular filling pressures. In addition, TTE is important in diagnosis and treatment of heart failure.

Although chest MRI and chest CT can be adjunctive tests in patients with heart failure, neither is recommended for the initial assessment of patients with suspected or known heart failure. Similar information from both tests is gleaned from 2D echocardiography, which does not expose the patient to ionizing radiation as CT would and is less expensive and more widely available than MRI. However, cardiac MRI is useful for evaluating congenital cardiac abnormalities and valve abnormalities and is the gold standard for assessing right ventricular function after routine 2D echocardiography. Carotid artery ultrasound is useful in revealing structural details of the carotid arteries, to look for blood clots, atherosclerotic plaque buildup, and other blood flow problems.

Innovations in cardiac imaging are driving the field forward.

For additional information, refer to the following clinical practice guidelines:

  • 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

  • 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America

  • 2021 European Society of Cardiology (ESC) Acute and Chronic Heart Failure Guidelines

Learn more about imaging studies in the workup of heart failure.


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