Diagnosis of Heart Failure Sometimes only clinical evaluation Chest x-ray Echocardiography, cardiac radionuclide scan, and / or MRI BNP or N-terminal-pro-BNP (NT-pro-BNP) levels ECG and other tests for etiology as needed Clinical findings (eg, exertional dyspnea or fatigue, orthopnea, edema, tachycardia, pulmonary crackles, S3, jugular venous distention) suggest heart failure but are usually not apparent early.