Breath Test for Heart Failure?

March 26, 2013

News Review from Harvard Medical School – Breath Test for Heart Failure?

An experimental test may eventually help to diagnose heart failure. The test uses a person's exhaled breath. Molecules in the breath are analyzed using a technique called mass spectrometry. Certain molecules and combinations of molecules can signal heart failure. The test was done on 77 patients. Some had already been diagnosed with heart failure. Others did not have signs of heart failure. The test identified all of the heart-failure patients. Doctors say the test may one day be useful in primary-care physicians' offices. It is still in the early stages of development. The study was published March 25 in the Journal of the American College of Cardiology. HealthDay News wrote about it.

By Howard Lewine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

I wish we had a different name for the condition we call "heart failure." Heart failure doesn't actually mean that your heart is failing and will never recover. Doctors use the term heart failure to describe a basket of conditions with one common theme—the heart does not pump blood as efficiently as it should.

But a heart that is "failing" can improve. And in fact sometimes heart function returns to normal.

Heart failure most often occurs because the muscle cells of one or both lower heart chambers (the ventricles) have become either too weak or too stiff. In some cases, they are weak and stiff at the same time. There are other reasons for heart failure, such as a faulty heart valve.

Doctors consider a diagnosis of heart failure when a person develops shortness of breath and fatigue with exertion. But other heart conditions and lung problems can cause the same symptoms. And so can a low red blood cell count (anemia).

People with heart failure don't always have the classic physical exam findings. In fact, the heart and lung exam may be normal. Also doctors look for swelling in the ankles and feet (edema) from fluid back-up. But many people with heart failure don't have edema.

Wouldn’t it be great to have simple office test to diagnose heart failure? Dr. Raed Dweik and his colleagues at the Cleveland Clinic may have discovered such a test. It’s a simple breath test. The patient blows out a breath into an analyzer. That’s all. It’s way too early to predict if this test will be as accurate as these early results suggest. And then it must be shown that the equipment to run the test is not too expensive. There is already a blood test for heart failure that is very good. So, the breath test needs to cost less or be more accurate or both before it becomes a standard diagnostic tool.

What Changes Can I Make Now?

In the United States, the most common causes of heart failure are coronary artery disease, poorly controlled high blood pressure and excess use of alcohol. These diseases can be prevented. By preventing them, you greatly lower your risk of ever developing heart failure.

Here's what you can do:

• Eat a healthy diet and don't take in more calories than you burn.
• Exercise regularly, starting today.
• Limit alcohol to an average of one drink a day for women and no more than two per day for men.
• Get your blood pressure checked regularly and lower it if necessary.
• Don't smoke.

What Can I Expect Looking to the Future?

Even if the breath test becomes widely used, doctors will still need to order additional testing to determine the type of heart failure—weak heart muscle, still heart muscle or leaky valve. This requires an echocardiogram.

From there, more tests are needed to get to the underlying cause of the heart failure to direct therapy.