• Testing for Heart Valve Disease


    If your doctor suspects a problem with a valve in your heart, he or she may order tests to determine if your heart is working as it should. The following diagnostic tests are among those used to detect heart valve disease:


    An echocardiogram, or cardiac ultrasound, is a non-invasive test that shows how well your heart is pumping blood, the size and shape of your heart valves and chambers, and if a valve has become narrowed or is allowing blood to flow or leak backward.

    An echocardiogram creates a moving picture of your beating heart through the use of sound waves. Sound waves are transmitted toward your chest with a wand. "Echoes" from the waves that bounce off the heart are converted into pictures of your heart on a computer screen. (Other tests that use sound waves to detect a heart valve problem include ultrasound and Doppler echocardiogram.)

    If you have valve disease, your doctor will probably recommend that you have an echocardiogram every six or twelve months to monitor the progress of the disease. Because echocardiograms are such an important part of monitoring valve disease, if possible, have them done at the same location for easier comparison. Unlike other tests, echocardiograms can vary significantly from one place to the next. The images obtained by the echocardiogram are very dependent on the skill of the technologist performing the test. Check with your doctor to find out where he or she recommends that you have your echocardiograms.

    Transesophageal Echocardiogram (TEE)

    To get a better image of your heart, your doctor may recommend a TEE. Medications are given through the IV to put you to sleep as a sound wave wand, positioned on the end of a thin tube, is passed down your throat into your esophagus. The heart structures are then viewed through the thin wall of the esophagus. This is not a painful procedure because you are asleep during the test.

    Electrocardiogram (ECG, EKG)

    A simple test usually done in the doctor's office, an ECG (or EKG) detects and records the electrical activity of your heart. An electrocardiogram can reveal an irregular heartbeat, signs of a previous heart attack, and whether certain chambers of your heart are enlarged.

    Chest X-ray

    A chest X-ray can show enlarged sections of your heart, fluid in your lungs and calcium deposits in your heart.

    Stress Test

    A stress test shows if you have symptoms of heart valve disease when your heart is working hard. It helps your doctor assess how severe your disease might be. Stress tests involve either exercising or taking medication to make your heart beat fast while images are taken of it.

    Cardiac Catheterization (also called Angiography orAngiogram)

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    What Will You See in the Cath Lab? Angiogram tests and angioplasty procedures are performed in special hospital rooms called cardiac cath labs. In this video, Dr. John P. Reilly gives you a guided tour of the cath lab, pointing out the equipment you’ll see and explaining what it’s for. (Video provided courtesy of Dr. Reilly)

    Your doctor may recommend cardiac catheterization if he or she continues to have questions after seeing your echocardiogram results. Cardiac catheterization can help assess if your symptoms are due to a valve problem or if they relate to a blockage in your artery—an indication of coronary artery disease (CAD). Ultimately, the catheterization provides detailed information that enables your doctor to develop the best plan for treating your condition.

    Catheterization is performed in a hospital's catheterization laboratory, or "cath lab." During cardiac catheterization, you are given medications to relax, but most people remain awake through the procedure. The injection of medicine to numb the area where a small, thin tube called a catheter is inserted in a blood vessel is the only discomfort most people feel.

    The catheter is inserted into a blood vessel in the crease of the upper leg or in the wrist, and threaded through the arteries into your heart. X-ray images help the doctor guide the catheter. Because there are no nerves in the blood vessels, you do not feel the catheter moving through your arteries or experience pain.

    CT (Computed Tomogram, or CAT Scan)

    CT scans take a series of X-ray images and compile them to create a 3-dimensional image of a portion of the patient's body. For diagnosing heart valve problems, CT scans are used to obtain pictures of the heart chambers and arteries. This is not the most common modality to evaluate or monitor valvular heart disease.

    Cardiac MRI (Magnetic Resonance Imaging)

    Cardiac MRI is a noninvasive medical test that uses a powerful magnet, radio waves and a computer to make detailed images of the heart. Images from a cardiac MRI image can provide more detailed information about valve defects than other tests. Images from a cardiac MRI can help the surgeon plan a heart valve surgery.

    Why Continous Testing Is Needed with Heart Valve Problems

    Heart valve disease is often changes over time. Even when a heart valve condition was previously stable, it can progress quickly with serious consequences.

    Your doctor can monitor the condition of your valves in various ways.

    • During a detailed physical examination, your doctor will listen for changes in heart murmurs, extra heart sounds such as gallops, or quality of your pulses.

    • A series of electrocardiograms (EKGs) can detect changes in heart rhythm, heart chamber size and excessive chamber thickening.

    • A chest x-ray can be helpful in assessing heart enlargement and the condition of the lungs.

    • For a detailed look at valve function and assessment of narrowing (stenosis) or leakage (regurgitation or insufficiency), echocardiograms can be performed to compare the condition of the heart valve from previous evaluations.

    Since symptoms related to valve problems can be slow to develop and notice, your doctor may recommend an exercise stress test as an objective test to compare how well your body is able to deal with a valve problem.

    An even more sophisticated test is a cardiac CT (computed tomography) or an MRI (magnetic resonance imaging) scan, which can give very detailed measurements and assessment of heart and valve function.

    Sometimes it is very important to know the exact pressures in the heart chambers or lung vessels. The most accurate way to do this is through a cardiac catheterization.

    Check with your doctor to find out how often you should have additional testing to monitor your heart valve problems.