Your family doctor or internist may be the first to suspect that you have a heart valve condition. He or she may detect a heart murmur while listening to your heartbeat through a stethoscope. A heart murmur is an extra-or unusual-sound heard when the heart beats. A murmur can be faint or it can create a noticeable whooshing noise. Heart murmur is common-and most murmurs do not indicate a problem.
If your heart murmur is associated with symptoms of heart valve disease, such as tiredness and shortness of breath, your doctor may refer you to a cardiologist, a medical doctor who specializes in heart disease and treatment.
The cardiologist will perform a physical examination and order tests to determine if you have heart valve disease. If initial tests indicate a valve problem, other tests may be recommended to gather more details about your condition.
During the physical exam, the cardiologist will ask you about your symptoms, your medical history and your family's health history. He or she will listen to your heart and lungs and examine your feet and legs for swelling that may indicate that you are retaining excess fluid. In addition, the cardiologist will review your blood pressure and the rate at which your heart beats (pulse.)
Tests may be ordered to determine if your heart is working as it should. Among the diagnostic tests used to detect heart valve disease are the following:
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.)
Trans-esophageal 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 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, or EKG.
A simple test usually done in the doctor's office, an EKG detects and records the electrical activity of your heart. An EKG can reveal an irregular heartbeat, signs of a previous heart attack and whether certain chambers of your heart are enlarged.
A chest X-ray can show enlarged sections of your heart, fluid in your lungs and calcium deposits in your heart.
A stress test can show 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).
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. 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 catheter, a small, thin tube, is inserted in a blood vessel is the only discomfort most people feel.
A thin, flexible tube (catheter) is inserted into a blood vessel in the crease of the leg (groin), or 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 3D 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.
Cardiac MRI (magnetic resonance imaging).
Cardiac MRI is a non-invasive 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.