Heart failure is a condition in which the heart cannot pump blood efficiently enough to meet the body’s needs. This does not mean that the heart has completely stopped working, but rather that its pumping function is no longer strong enough or that the heart does not fill properly with blood between beats. Heart failure is one of the most common cardiovascular conditions, especially in people over the age of 60, and it is estimated to affect around 1–3% of the adult population.
Most common symptoms of heart failure
Symptoms of heart failure may develop gradually and are often initially mistaken for fatigue or aging. The most common symptoms include:
- Shortness of breath, especially during exertion or when lying down
- Rapid fatigue and reduced exercise tolerance
- Swelling of the legs, ankles, or feet
- Fast or irregular heartbeat
- Night-time breathlessness or waking up due to lack of air
- Feeling weak or having reduced physical fitness
These symptoms occur because the heart cannot pump blood efficiently, which leads to fluid retention in the lungs and other parts of the body.
How is heart failure diagnosed?
The diagnosis of heart failure is made through a combination of clinical examination, laboratory tests, and imaging diagnostic methods. There is not just one test that confirms the disease; rather, the diagnosis is based on the assessment of symptoms, physical examination, and additional investigations.
Current guidelines of the European Society of Cardiology (ESC) recommend a systematic approach that includes:
- Clinical examination and assessment of symptoms
- ECG (electrocardiogram)
- Laboratory tests
- Measurement of heart failure biomarkers (NT-proBNP)
- Echocardiography (cardiac ultrasound)
The presence of symptoms together with evidence of structural or functional changes in the heart confirms the diagnosis of heart failure according to ESC guidelines.
Cardiac ultrasound – a key examination in diagnosis
Cardiac ultrasound (echocardiography) is the most important method for assessing heart function in patients with suspected heart failure. This examination enables detailed assessment of:
- The pumping strength of the heart (ejection fraction)
- The size of the heart chambers
- The function of the heart valves
- Pressure in the pulmonary circulation
- Right ventricular function
- Diastolic heart function
Modern echocardiographic examination also enables advanced methods for assessing heart function, including Doppler analysis and evaluation of cardiac filling, which is particularly important for early detection of heart failure.
NT-proBNP – an important laboratory marker of heart failure
NT-proBNP is a biomarker released from the heart muscle when the heart is exposed to increased strain. Measuring NT-proBNP levels in the blood is now an important part of the diagnostic algorithm when heart failure is suspected.
Low NT-proBNP values practically rule out heart failure, while elevated values indicate the need for further cardiological diagnostics, primarily cardiac ultrasound.
ESC guidelines recommend NT-proBNP as one of the first tests in patients with symptoms that may suggest heart failure.
Comprehensive diagnostics at Dr Mačkić Clinic
At Dr Mačkić Internal Medicine Clinic in Sarajevo, it is possible to undergo a comprehensive cardiological assessment when heart failure is suspected. The examination includes a detailed cardiological examination, modern echocardiographic assessment of the heart, and laboratory testing of heart failure biomarkers.
Rapid NT-proBNP testing is also available at the clinic, and the test result is usually ready in approximately 15 to 20 minutes, enabling rapid assessment of the condition and treatment decisions during the same visit.
By combining clinical examination, cardiac ultrasound, and NT-proBNP analysis, it is possible to quickly and reliably assess whether the patient’s symptoms indicate heart failure and to start appropriate treatment or further diagnostic evaluation.
When should you see a cardiologist?
If you have symptoms such as shortness of breath, rapid fatigue, swelling of the legs, or a feeling of heart palpitations, it is advisable to undergo a cardiological examination. Early detection of heart failure enables timely treatment and significantly improves patients’ quality of life.
Modern medicine today offers effective therapies that can slow disease progression, reduce symptoms, and improve the prognosis of patients with heart failure.
References
- McDonagh TA et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal.
- ESC. Clinical Practice Guidelines for Heart Failure – European Society of Cardiology.
- Heidenreich PA et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.
- Bayes-Genis A et al. Practical algorithms for early diagnosis of heart failure and use of natriuretic peptides. European Journal of Heart Failure.
- Çelik A et al. Natriuretic peptides in the early diagnosis of heart failure. 2025 review.
- ESC Focused Update on Heart Failure Guidelines 2023.