7 Ways to Diagnose Heart Valve Disease
From X-rays to CT scans, your doctor’s got options when it comes to confirming HVD.
The most critical tool for diagnosing heart valve disease (HVD) doesn't use X-rays, sound waves, radio waves, or magnets. It's non-invasive and is as low-tech as could be (it doesn't even need to be plugged in!), but the simple stethoscope could save your life.
When listening to your heart with this over-200-year-old tool at a routine checkup, your doctor may notice an irregularity in the sound your blood makes as it rushes through the four chambers of your heart. This sound is called a murmur, and it may be a signal to your doctor that one or more of your heart valves—the “doors” that open and shut to allow normal blood flow in and out of the chambers—are not doing their jobs and that investigation is needed. The sound of your murmur can even tell your doctor if one of your valves is leaking (called regurgitation) or narrowed (stenosis) and a general sense of the severity of the issue, says Daniel Menees, M.D., an interventional cardiologist at the Michigan Medicine Frankel Cardiovascular Center in Ann Arbor.
While about 10% of adults (and 30% of children) have a harmless murmur, it's important to test further if your murmur was just detected for the first time or has changed at all in sound. These are some of the tools your doctor may use to learn more about what’s going on with your heart valves.
The likely next diagnostic step? An echocardiogram—an ultrasound of the heart—can confirm the specific anatomical causes of your valve problem as well as the severity of the regurgitation or stenosis. Echocardiology uses sound waves to make pictures of your heart and allows you and your doctor to measure the valve openings, detect calcification (or thickening of the valve tissue, which leads to stenosis), and see if blood is flowing backward through a valve (a sign of valve leaking or regurgitation).
Though an echocardiogram (commonly referred to as an “echo”) relies on more advanced technology than the stethoscope, it doesn't require much more from you. A sonographer will place electrodes (small metal discs) on your chest to monitor your heart's electrical activity during the test and then rub gel over your heart area. Next, the sonographer will lightly press a wand, called a sound-wave transducer, on different parts of your chest over the gel. The harmless sound waves from the transducer bounce off the varied parts of your heart to create images that will appear on a video monitor. The whole thing shouldn't take more than an hour.
The images created from the echo, along with your particular symptoms, will help your doctor decide if more testing is necessary, says Amar Krishnaswamy, M.D., section head of invasive and interventional cardiology at the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic in Ohio. These determinations will be unique to your case. “If a patient has shortness of breath, for example, and we think they might have a mitral valve regurgitation, the echo might not give us an accurate idea of the extent of the regurgitation,” says Dr. Krishnaswamy. In that case, he would recommend a transesophageal echocardiogram. If he suspects aortic stenosis, he would order a cardiac MRI. A chest X-ray, meanwhile, is helpful for checking to see if HVD has caused a backup of fluid in the lungs.
These additional tests “impact the decision in how to treat the valve disease and help guide the use of medications necessary for optimal management,” says Dr. Menees. After your echocardiogram, you may need one or more of these follow-up diagnostic tests—or you may need none. Getting more or less does not mean that your doctor is more or less thorough—it depends on what the initial results show. Let's take a closer look at what might be recommended:
In this more specific echo test (it uses high-frequency sound waves just like a standard echocardiogram), a small transducer attached to a flexible tube is guided down your esophagus to get a closer look at the mitral valve. Don't worry, your throat will be numbed and you may be given a mild sedative; though you may feel the tube and transducer moving, you won't feel pain.
If you've ever broken or sprained a limb or digit, you've most likely had an X-ray before. A chest X-ray is the same process: A technician will ask you to lie in a certain position on the X-ray table and hold your breath for a few seconds while the machine flashes radiation to get an image. Chest X-rays have the benefit of showing whether or not there is fluid in the lungs, a sign of possible heart failure caused by a leaking valve.
Cardiac magnetic resonance imaging (MRI) uses a harmless magnetic field and radio waves to produce 3D moving images of your valves and chambers. The images produced are clearer than those from an echocardiogram and may give your doctors a better idea of the functionality of your heart—and exactly how blood is moving through your four valves.
For this procedure, you will lie down on a narrow bed that's rolled into the MRI machine. There, you will be asked to stay motionless for about 30 minutes or so. If you have any metal in your body, you can't get an MRI, so be sure to let your doctor know about stents, pacemakers, or joint replacements. If you're very claustrophobic, your doctor may recommend another type of test or prescribe a mild sedative for the procedure.
Computed tomography, also called a multidetector CT (or MDCT), uses multiple fast X-rays to create detailed, cross-sectional images of your beating heart. These images can pinpoint exact spots of blockages and calcium deposits that may be preventing a valve from fully opening or closing. This test is often done as a less-invasive alternative to cardiac catheterization just prior to surgical intervention, to help guide the surgeons. The process for an MDCT is much like getting an MRI; you'll lie down and be guided into a tube for five to 10 minutes while the scans are taken. Electrodes may be placed on your chest and sometimes a contrast dye, administered through an IV in your arm vein, is used.
This invasive test used to be the gold standard in pre-operation HVD diagnostics but is used more rarely now that there are more non-invasive options available. Still, says Dr. Krishnaswamy, it may be necessary if stenosis is suspected in your coronary arteries as well as a valve. During the procedure, a catheter (a narrow, flexible tube) is inserted into an artery in the groin area and threaded up and into the heart. Various instruments can be attached to the end of the catheter to perform different functions: Your doctor might measure the blood pressure inside your heart, take X-rays, procure a biopsy, or even insert a stent. You'll be given a local anesthetic and an IV sedative, but you'll still be awake.
The bottom line: Heart valve disease is serious, but there are treatments available, and finding the right one for you starts with identifying exactly what's going on with your valves. Ask you doctor about the tools here to get started on the path back to wellness.
Heart Murmurs: Harvard Health Publishing. (2018). "Heart Murmur." health.harvard.edu/a_to_z/heart-murmur-a-to-z
Testing Overview: Mayo Clinic Proceedings. (2010). “Valvular Heart Disease: Diagnosis and Management.” ncbi.nlm.nih.gov/pmc/articles/PMC2861980/
CT Scans: WebMd. (2006). “Imaging the Heart: The New Frontier.” webmd.com/heart/features/imaging-heart-new-frontier