The diuretic effects of inorganic mercury salts, which were used to treat syphilis, had already been noted in the 16th century by Paracelsus; in the 19th century they were used by noted physicians like John Blackall and William Stokes. In the meantime, cannulae (tubes) invented by English physician Reginald Southey in 1877 was another method of removing excess fluid by directly inserting into swollen limbs. Use of organic mercury compounds as diuretics, beyond their role in syphilis treatment, started in 1920, though it was limited by their parenteral route of administration and their side-effects. Oral mercurial diuretics were introduced in the 1950s; so were thiazide diuretics, which caused less toxicity, and are still used today. Around the same time, invention of echocardiography by Inge Edler and Hellmuth Hertz in 1954 marked a new era in the evaluation of heart failure. In the 1960s, loop diuretics were added to available treatments of fluid retention, while a patient with heart failure received the first heart transplant by Christiaan Barnard. Over the following decades, new drug classes found their place in heart failure therapeutics, including vasodilators like hydralazine; renin-angiotensin system inhibitors; and beta-blockers.
As a result, coronary catheterization may be used to identify possibilities for revascularisation through percutaneous coronary intervention or bypass surgery. Algorithms
Various algorithms are used for the diagnosis of heart failure. For example, the algorithm used by the Framingham Heart Study adds together criteria mainly from physical examination. In contrast, the more extensive algorithm by the European Society of Cardiology  weights the difference between supporting and opposing parameters from the medical history, physical examination, further medical tests, and response to therapy. Framingham criteria
By the Framingham criteria, diagnosis of congestive heart failure (heart failure with impaired pumping capability) requires the simultaneous presence of at least two of the following major criteria or one major criterion in conjunction with two of the minor criteria. Major criteria includean enlarged heart on a chest X-ray,
an S3 gallop (a third heart sound),
acute pulmonary edema,
episodes of waking up from sleep gasping for air, crackles on lung auscultation,
central venous pressure more than 16 cm H2O at the right atrium,
jugular vein distension,
positive abdominojugular test, and
weight loss more than 4.5 kg in 5 days in response to treatment (sometimes classified as a minor criterion).Minor criteria includean abnormally fast heart rate more than 120 beats per minute,
nocturnal cough,
difficulty breathing with physical activity,
pleural effusion,
a decrease in the vital capacity by one-third from maximum recorded,
liver enlargement, and
bilateral ankle edema.Minor criteria are acceptable only if they can not be attributed to another medical condition such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome.