Objective test to determine if I have Congestive Heart Failure?

[OldTiredSailor]

During the last 5-years my GP (board certified Internal Medicine physician) and Cardiologists (three - all board certified and in same practice) have told me I have Congestive Heart Failure. None of them have been able to tell me what test results or examination results lead to that diagnosis.

I am 77-years old and in relatively good health other than metastatic prostate cancer and well controlled hypertension (130/75 on 12.5 mg Metoprolol). I have been a very serious runner and bicycle rider my entire life. I have never smoked, drink very little alcohol, and eat no red meat and very little processed food.

I engage in strenuous physical activity for at least 90-minutes per session five times a week. My heart rate averages over 110 during the exercise and I can comfortably keep the HR at 130 for many minutes at a time. I never have a shortness of breath, chest or arm pains, or any sense of discomfort. My HR drops to 70 within 2-minutes of sitting down. My resting HR, just prior to getting out of bed is 50 - 52 bpm.

I have had many nuclear stress tests and echo cardiograms during the last 20-years. My ejection fraction is 62% to 65% in every test.

My lipids are all in the low normal range and have not varied 5% during the last 30-years. The most recent cardiology exam resulted in a diagnosis of hyperlipidemia but my most recent lipid panel shows: Triglyceride mg/dL was 78, HDL 55, LDL 45, total cholesterol 116.

My PRO BNP blood test was 28 in 2014 and 98 in 2020.

The only thing the cardiologist mentions as indicative of Congestive Heart Failure is Coronary Hypertrophy and an enlarged aorta. I reminded her this is a long term indicator first noted over 25-years ago. In 1999 an echocardiogram noted: Aortic root diameter of 4.0 cm. The LA diameter was 4.1 cm, LVIDd was 4.7 cm and LVIDs 3.1 cm.

Three more recent cardiograms, in 2014, 2020 and 2024 reported the exact same measurements.

I have none of the Congestive Heart Failure symptoms shown on various web sites. Is there some other objective test I can request?

What impact would Congestive Heart Failure have on my life with the test results I describe and the total lack of symptoms?

[OldTiredSailor]

A cardiac angiogram in summer 2023 found one coronary artery was 40% blocked. But, the hemodynamics showed excellent flow and pressure and the cardiologist chose to not insert a stent. A CT with contrast Angiogram in March 2025 found exactly the same blockage. No other blockages of note were reported.

[FlyJ]

You don't seem to have any indication of significant systolic CHF (no symptoms, great exercise tolerance, normal left ventricular ejection fraction. Is there evidence of diastolic dysfunction - abnormal relaxation of the ventricles with poor filling? There should be some mention of diastolic function on your tests ( echos and nuclear stress tests)

[OldTiredSailor in reply to FlyJ]

Every echo I have had during the last 30-years reports everything normal, except for the enlargement.

Between ages 25 and 65 I ran and bicycle for at least 60-minutes every day with an average HR over 145. I could easily run at 165 BPM for extended periods. I did much of that work in remote mountainous areas on small or non-existent trails. My wife insisted I have a complete cardiovascular checkup at least every 5-years.

She really wanted to make sure I came home after my wilderness forays.

My VO max was 52 (mask test in a lap) at age 45. Recent last accurate VO max tests indicate it is still above 40. I can comfortably bicycle for an unlimited time at a HR of 140 in complete comfort.