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Other testing for the severity of heartworm in dogs may include: Chest radiographs to identify heart enlargement, inflammation, and signs of heart failure EKG to check the heart rhythm Blood pressure Cardiac enzyme evaluation (NT-proBNP) to identify the severity of heart failure Echocardiogram to check how the heart pumps and identify any obstructions (such as heartworms) Additional blood work to assess blood cells and other organ functions Urine testing (urinalysis) to check for protein in the urine as a result of the immune systems response to heartworm infection Class I dogs are those with the lowest amount of risk for treatment, and Class IV dogs are those often diagnosed with caval syndrome and are at highest risk