Heart Valve Disease Diagnosis and Testing

How is heart valve disease diagnosed?

To check for heart valve disease, your healthcare professional may start with a physical exam. They may listen to your heart with a stethoscope and check for unusual sounds, such as a heart murmur. You may be asked to change positions or tighten your stomach muscles so they can hear whether the sound changes.

A heart murmur is an extra sound during a heartbeat. Some heart murmurs are harmless, known as an innocent murmur. Others may be a sign that a heart valve is too narrow (stenosis) or is leaking (regurgitation). If your healthcare professional hears a murmur, you may need more testing to find out what is causing it.

Which tests are used to diagnose heart valve disease?

If your healthcare professional suspects heart valve disease, you may need tests to learn more about your heart and valves. These tests can help show:

• Whether you have symptoms of valve disease
• Whether you have other heart conditions
• How your heart valves look and work
• How blood flows through the valves
• Whether the condition is affecting your heart and other organs

An echocardiogram (echo) is usually the first test used to evaluate heart valve disease. It uses sound waves to create pictures of your heart and shows how well your valves are working.

Depending on your symptoms and echo results, your healthcare team may recommend other tests, including:

Electrocardiogram (EKG): Checks your heart’s electrical activity and rhythm

Exercise stress test: Shows how your heart responds to physical activity

Chest X-ray: Provides a picture of your heart and lungs

Cardiac computed tomography (CT) scan: Creates detailed images of the heart and valves

Cardiac catheterization: Measures pressures and blood flow inside the heart when additional information is needed

Cardiac magnetic resonance imaging (MRI): Provides detailed images of the heart and can help evaluate valve disease in some people

Echocardiogram

What is an echocardiogram?

An echocardiogram (echo) is a test that uses sound waves (ultrasound) to create pictures of your heart. It is the standard test used to evaluate heart valve disease. It is also called echocardiography.

Why do I need an echocardiogram?

An echo shows how your heart and heart valves look and work. It can provide information about:

• The size and shape of your heart
• How well your heart muscle pumps blood
• How well your heart walls move
• Whether your heart valves are working properly
• Whether blood is leaking backward through a valve (regurgitation)
• Whether a valve is too narrow (stenosis)
• Whether there are other changes, such as a growth or abnormal tissue, affecting your heart valves 

Measuring the valve gradient

The valve gradient is the difference in pressure on each side of a heart valve. When a valve becomes narrowed (stenosis), blood has a harder time flowing through it. This increases the pressure difference across the valve. Healthcare professionals use the valve gradient to help determine how severe the valve problem is.

A leaking valve (regurgitation) can also affect pressure in the heart chambers and nearby blood vessels.

Measuring the valve area

Valve area refers to the size of the valve opening. During an echocardiogram, it is measured in square centimeters. The valve area can help determine how severe a valve problem is.

Measuring ejection fraction 

Ejection fraction measures how much blood the left ventricle pumps out with each heartbeat.

A normal left ventricular ejection fraction is generally 50% or higher. A lower ejection fraction can be a sign that the heart is not pumping efficiently.

Learn more about ejection fraction.

Exercise stress test

Why is an exercise test sometimes used for heart valve disease?

Also called a stress test or treadmill test, an exercise stress test can provide more information about heart valve disease. This is especially true when symptoms are unclear or difficult to assess.

Your healthcare team may use an exercise test along with other tests, such as:

• Echocardiography
• EKG
• Chest x-ray
• Cardiac catheterization

An exercise stress test helps show how your heart responds to physical activity. It can help evaluate changes in blood pressure, symptoms and exercise capacity. Because symptoms of heart valve disease can develop slowly, people may not notice that they are becoming less active over time and may assume it is a normal part of aging. 

Read more about exercise testing.

Chest X-ray

What is a chest X-ray?

A chest X-ray creates pictures of the heart, lungs and bones in the chest. It can show the heart’s overall size and shape, but it cannot show the inside structures of the heart.

Why is it used for someone with heart valve disease?

A chest X-ray can show the size and shape of the heart and major blood vessels. It may also show changes in the lungs that can occur when heart disease affects blood flow. This information can help your healthcare team learn more about your condition. 

Read more about chest x-ray procedures.

CT Scan

What is a CT scan?

A cardiac computed tomography (CT) scan uses a series of X-ray images to create detailed pictures of the heart and heart valves. It can provide more information about valve structure and function.

Why is a CT scan used for heart valve disease?

An echocardiogram is usually the first test used to evaluate heart valve disease. In some situations, a CT scan may be used to provide more information when an echocardiogram does not provide enough detail.

A CT scan can create detailed images of the heart valves and nearby structures. It may help your healthcare team further evaluate valve disease and plan treatment when needed.

Read more about CT scans.

Cardiac catheterization

How does cardiac catheterization help diagnose valve disease?

Cardiac catheterization is commonly used to evaluate the heart’s blood vessels, but it can also provide important information about heart valve disease. The procedure can measure pressures inside the heart and lungs. It can also help assess how severe a heart valve problem may be.

View an illustration of cardiac catheterization.

For people with valve disease, cardiac catheterization may:

• Measure pressure inside the heart and lungs
• Assess the severity of a valve problem
• Provide more information when symptoms or imaging test results are unclear
• Help guide treatment decisions

Cardiac catheterization is a minimally invasive procedure. It is not needed for everyone with a heart murmur or valve problem. It may be recommended when other tests, such as an echocardiogram, do not provide enough information.

Read more about cardiac catheterization.

Cardiac magnetic resonance imaging

Cardiac magnetic resonance imaging (CMR), also called cardiac MRI, is a painless, noninvasive imaging test that shows the heart’s structure and function. It uses radio waves, magnets and a computer to create detailed pictures of your heart.

CMR may provide more information about heart valve disease in some people. It can help:

• Determine the type and severity of valve disease
• Measure heart function, including how much blood the left ventricle pumps with each heartbeat

Most people with heart valve disease do not need a CMR. Your healthcare team may recommend it when more information is needed. This test does not use radiation.

Before having a CMR, tell your healthcare team if you have any implanted devices or metal in your body. Many people with artificial heart valves, stents and other implanted devices can safely have an MRI, but your healthcare team will need to confirm that it is safe for you.

Talk with your doctor before having a CMR. For example, be sure to tell your healthcare team if you:

• Have a stent or artificial heart valve, or have recently had open-heart surgery
• Are pregnant, especially during the first three months
• Have tattoos or permanent (tattooed) makeup. In rare cases, you may feel mild discomfort or a warming sensation on your skin.
• Have been told you have kidney problems

Read more about magnetic resonance imaging.