Q. When a patient comes into the ER presenting of chest pain indicative of a heart problem, what are the different tests that could be run to diagnose heart failure, and how can different levels of heart failure be classified? A. Initially, the doctor will perform a physical examination, review the symptoms, and take a careful medical history to check for the presence of risk factors such as high blood pressure, coronary artery disease or diabetes. Many different tests may then be ordered — a blood test (check kidney, liver, thyroid function), chest xray (see if heart may appear enlarged or if fluid buildup is visible in the lungs), ECG (detect any heart rhythm problems), echocardiogram (detect how well the heart is pumping), CT, MRI, a coronary angiogram (determine strength of left ventricle), and myocardial biopsy (take part of the heart muscle to diagnose heart muscle diseases). After performing the tests deemed appropriate by the doctor, the heart failure can be classified with two systems: New York Heart Association Classification (symptom-based scale), and the American College of Cardiology/American Heart Association guidelines (stage-based classification). These are both scoring systems that doctors use in order to devise a treatment plan. The patient that I saw specifically was considered low risk and kept in the ER for monitoring after performing a blood test. This decision was based off of the patient’s age and the information that he had experienced the symptoms for the past two years. If the same symptoms and signs were seen in a younger individual and were large changes from what’s normal for the patient, the patient would have been classified as someone needing more urgent and specialized treatment. Resources: www.mayoclinic.org