[Diagnostic procedures in chronic heart failure. What is necessary, significant, contraindicated?]

The most common causes of the heart failure syndrome are coronary heart disease, dilated cardiomyopathy, secondary decompensated hypertension and cardiac defects. Apart from the establishment of the diagnosis, essential diagnostic aims are the clarification of the etiology, the identification of reversible causes, the clarification of specific therapeutic options, assessment of severity and evaluation of the prognosis. A standardized diagnostic work-up based on current consensus recommendations, makes good sense. Symptoms and clinical findings have limited sensitivity and specificity. The leading diagnostic procedure is (Doppler) echocardiography. In the case of ischemic cardiomyopathy, the angiographic coronary status and myocardial vitality evaluation are necessary to clarify the revascularisation option. Further diagnostic examinations (invasive hemodynamics, myocardial biopsy, CT/MRI, ergospirometry, markers of neurohormonal activation) should be carried out as dictated by the individual situation. In patients with an increased risk of developing heart failure (e.g. post-myocardial infarction status, essential hypertension, diabetes mellitus) the aim should be the early detection of an asymptomatic ventricular dysfunction by means of echocardiography.