Diagnosis starts with a physical exam to look for signs that your heart is not pumping as it should. You may also have a chest X-ray to see if your symptoms are related to heart failure. The X-ray can show if your heart muscle is enlarged or if fluid is building up in your lungs.

We may also do blood tests to see whether your heart is supplying enough oxygen-rich blood to organs such as your kidneys, liver and brain.

Your doctor will often monitor your heart to see how it responds when asked to work harder. This is called a stress test. It can be done in a few ways. You may exercise on a stationary bike or treadmill. If it’s difficult for you to exercise, you may take medication to make your heart work harder.

In some cases, you may have a nuclear stress test. This test uses a small amount of radioactive dye and imaging technology to capture pictures of your heart when you exert yourself.

Images can help us see exactly what is happening to weaken your heart. OHSU has world-class imaging specialists. We also invest in sophisticated cardiac imaging technology.

This includes:

Electrocardiogram (EKG or ECG): This test measures and records the heart’s electrical activity as a series of lines, waves and spikes. We use the results to understand the timing of your heartbeats and to find clues about structural changes to the heart muscle.

Echocardiogram (echo): An echocardiogram is an ultrasound of the heart. It uses sound waves to create moving images of the heart. It shows the heart’s structures and blood flow as the heart pumps. We use it to see how the ventricles and valves are working, and how thick the heart muscles are. Learn more.

Cardiac MRI (magnetic resonance imaging): This test uses radio waves and a strong magnet to show clear, detailed images of your moving heart. MRI allows us to measure blood flow and to see if the heart muscle is inflamed, scarred or stiff. Learn how it works.

Diagnostic heart (cardiac) catheterization: This test uses a long, thin, flexible tube called a catheter to reach your coronary arteries and identify any blockages. The experts in our state-of-the-art cardiac catheterization lab will insert the catheter into a vein or artery, usually in the groin, and guide it into place. A small amount of dye is then injected and tracked using X-ray imaging as the dye passes through the arteries.

PET (positron emission tomography) scan: This test uses a small amount of a radioactive substance called a tracer. It is added to your blood through an IV. The tracer can highlight areas where your heart may not be working as it should. We use it to check your heart’s blood flow and look for signs of damage to the heart muscle.

ACE inhibitors, ARBs and ARNIs: These medicines limit the effects of a hormone that narrows blood vessels. This in turn lowers blood pressure and reduces stress on the heart. These medications can improve heart failure symptoms, slow the disease and improve chances of survival. They are also called angiotensin converting enzyme inhibitors, angiotensin receptor blockers and angiotensin receptor neprilysin inhibitors.

Beta blockers: These medications are important for managing heart failure. Beta blockers limit the effects of adrenaline so your heart doesn’t work as hard. The heart beats slower and with less force, lowering blood pressure and possibly reducing chest pain. Beta blockers also improve blood flow and prevent irregular heart rhythms (arrhythmia).

Blood thinners: These medications, also called anticoagulants or antiplatelets, reduce the risk of blood clots. Blood thinners can lower the risk of heart attack, stroke or clots in the lungs (pulmonary embolism). Warfarin is a common anticoagulant. Aspirin is a common antiplatelet.

Calcium channel blockers: These medications block calcium from your heart and arteries, lowering blood pressure. Calcium channel blockers can treat heart failure caused by high blood pressure when other medications don’t work. They can also prevent angina (chest pain caused by limited blood flow to the heart).

Ivabradine (Corlanor): This medication treats chronic heart failure by slowing the heart rate. It can keep heart failure from getting worse, preventing hospitalization.

Digoxin: Also called digitalis, this medication improves heart muscle function and treats rhythm disorders such as atrial fibrillation. It works by controlling how much sodium and potassium reaches the heart. This reduces strain and helps maintain a strong heartbeat.

Diuretics: Also called “water pills,” diuretics help the body shed excess water and salt. This can reduce swelling, making it easier to breathe and easier for the heart to pump. Loop diuretics can lower levels of potassium, an electrolyte that helps the heart work. If you have severe heart failure, potassium-sparing diuretics may be a better option.

Hydralazine: This medication treats high blood pressure. A vasodilator, it works by widening blood vessels to improve blood flow and allow more oxygen-rich blood to reach the heart. Hydralazine may be combined with nitrates to take stress off the heart in people with congestive heart failure.

Nitrates: These blood pressure medications are vasodilators. Nitrates widen blood vessels, improving blood flow and reducing chest pain from angina. They can also relax veins so the heart doesn’t work as hard when blood returns from the arms and legs.

Statins: This type of medication lowers cholesterol in the blood. Statins prevent a waxy substance called plaque from building up in arteries. Plaque can limit blood flow to and from the heart. Statins can prevent heart attacks in people who are at high risk.

Pacemaker: This battery-operated device is implanted under the skin, just below your collarbone. About the size of a silver dollar, a pacemaker helps the heart beat regularly. It sends electrical impulses if the heart beats too slowly and withholds these impulses if it beats normally or too fast.

Cardio-MEMS: This monitoring device is placed in the blood vessel that moves blood from your heart to your lungs (pulmonary artery). It continuously measures your heart rate and lung filling pressures. It sends daily data to your care team. Cardio-MEMS is available only through heart specialty programs such as OHSU’s. It allows us to monitor you remotely, so you can stay at home and avoid being in the hospital.

Automatic implantable cardioverter defibrillator (AICD): This device, placed under the skin like a pacemaker, combines a pacemaker with a heart rhythm monitor. If your heart rate is elevated or abnormal, it can deliver an impulse to restore normal rhythm.

External vest defibrillator: This personal defibrillator is in a vest worn on the body. Your care team may suggest it as a temporary option while considering an AICD.

Intra-aortic balloon pump (IABP): This type improves blood flow when you are in the hospital. It controls flow through the main blood vessel, the aorta, and increases the heart’s ability to pump. A long, thin balloon rests in your aorta. It is connected to a computer through a flexible tube called a catheter. The computer inflates the balloon when your heart is relaxed and deflates it when your heart pumps.

Percutaneous heart pump: Also called a percutaneous ventricular assist device (PVAD), this type of heart pump is not implanted in the body. It connects to the circulatory system through tubes placed in an artery. It temporarily takes over pumping of the right or left side of the heart during a heart procedure or after a heart attack.

Ventricular assist device (VAD/LVAD): If you have severe heart failure and other treatments haven’t worked, a ventricular assist device may be an option. VADs help circulate blood in weakened hearts. They are implanted in your chest or abdomen and powered by batteries worn outside the body. VADs deliver blood from the heart’s lower chambers to the rest of the body. You may get a VAD while waiting for a heart transplant or as an alternative to a transplant.

Resynchronization therapy: A heart rhythm problem, such as atrial fibrillation (AFib), may keep your heart from filling up with blood to pump to the rest of your body. Resynchronization therapy uses a special kind of pacemaker to restore an irregular heartbeat. It sends impulses to the right and left sides of the heart to make sure they contract (squeeze) at the same time.

Our team works closely with experts in OHSU’s electrophysiology program to give you the best possible care for heart rhythm disorders. In some cases, you may be able to see a heart failure specialist and a heart rhythm specialist at the same time.

Your arteries (large blood vessels) can become blocked over time, reducing blood flow to your heart. Our team works with experts in surgery and minimally invasive procedures to improve heart function even in complex cases.

Procedures to clear a clogged coronary artery include:

Percutaneous coronary artery stenting (PCTA): A specialist will use a catheter to reach your coronary arteries and identify blockages. Blocked areas will be cleared with a small instrument that has a thin wire and special balloon. You may have a mesh tube (stent) inserted to hold the blood vessel open.

Coronary artery bypass grafting (CABG): A surgeon takes a blood vessel from another part of your body and attaches it to your coronary artery above and below the blockage, rerouting blood flow. Bypass grafts relieve symptoms of coronary artery disease. When combined with medication, CABG can slow heart failure.

Your heart has small openings called valves that open and close to control blood flow. When valves don’t work properly, it’s called heart valve disease. The main types are stenosis (narrowing of a valve) and regurgitation (a leaking valve.)

If you have heart valve disease, we’ll work with experts from OHSU’s nationally recognized heart valve program to tailor your treatment.

Valves that leak or need replacement can be treated with surgery or a less-invasive option using a catheter. OHSU’s valve experts are known for pioneering work in nonsurgical treatments.