Diagnosing Valve Disease

The technological revolution continues to develop ever more rapid, accurate methods for diagnosing and treating diseases of the heart. These innovations offer a faster, clearer picture of the heart essential for early detection and treatment, and continually advance the boundaries of cardiac care and preventive medicine. Our Valve Clinic provides cutting-edge diagnostic services, along with some of the most highly skilled, highly-trained and intuitive diagnostic specialists in the country.

So, how is valve disease diagnosed? If you’re experiencing symptoms, or have certain risk factors for valve disease, what’s next?

Physical exam

There are many high-tech options for accurate diagnosis of heart valve problems, but in some ways, the most important is the very first line of defense in diagnosing heart disease of all kinds: a skilled physical exam by your physician. Your primary care physician is trained to recognize signs and symptoms that point to the need for a specialist consultation. Cardiac physicians are also skilled in both overt symptoms and evaluating subtle clues that help them determine which diagnostic methods will most effectively pinpoint the condition of your heart.

Your physician will begin by taking your history – a discussion of your symptoms, family history, and risk factors. This history - one of the keystones to effective diagnosis – is part of your physical examination, which includes evaluation of blood pressure and pulse, the color of your skin, inspection of the fingertips for characteristic signs of heart disease, testing for edema (retention of water in the tissues), external appearance of the chest and neck, palpation of the chest, neck, and abdomen, and other indicators.

Next, your physician will listen to your heart, a method called auscultation. Simply listening to the heart’s sounds, created by blood flow through the heart and the closing of the valves, can tell a skilled physician a great deal about the state of the heart’s structures and their functioning.

Diagnostic tests and procedures

As part of your diagnosis, you may also undergo one or more of the following tests:

Chest x-rays show the location, size and shape of the heart, lungs, and blood vessels. It can show whether certain parts of your heart are enlarged, and detect fluid in the lungs and the presence of calcium deposits. St. Helena Heart Institute uses advanced x-ray systems, including the Infinix^™ DP-i, an X-ray system that offers faster tests and more comfort for patients, and higher-quality images and advanced software capabilities to help cardiologists make the best possible treatment decisions.

Exercise stress test is a way of evaluating your heart’s function during activity. Some problems may not show up when your body is at rest, so your cardiologist may want to monitor your heart when it is working harder. Because exercise is most often used to induce this stress on the heart, the test is also known as a treadmill test, but in some cases a medication called debutamine may be used to mimic the effects of exercise. Your physician will evaluate your heart’s activity as you go from rest to activity, including changes in the electrical activity within the heart, blood pressure, your symptoms, and breathing rate. A type of stress test where radio-opaque dye is injected into the body and tracked with imaging techniques is known as a nuclear stress test. Stress testing may be used in combination with other tests.

Electrocardiogram (ECG or EKG) is usually performed in a doctor’s office to measure the electrical activity of the heart and regularity of heartbeats, using small sensors applied to the skin. It can detect irregular heartbeat, thickening of the heart muscle (hypertrophy), damage to the heart’s chambers, and heart muscle damage from coronary artery disease.

Echocardiogram (echo) is the main test used to diagnose heart valve disease. Using sound waves bounced off the heart to create a moving image of the heart in action, an echocardiogram can reveal abnormal heart size, shape or movement, whether valves are narrow or incompetent, and how effectively your heart is pumping blood to your body. There are two types of echo test:

• A transthoracic echocardiogram (TTE or “routine echo”) is performed by placing a transducer on the skin of the chest.
• A transesophageal echocardiogram (TEE), where the transducer is introduced into the esophagus under sedation, may be recommended by your cardiologist when a more detailed image is required. Because the transducer can be brought close to the heart without interference from the ribs and chest muscles, a more detailed picture can be created.

Computer tomography (CT) scanning is a technology that captures multiple x-ray images to create a cross-sectional image of the heart and lung. CT scans are often used when other testing methods do not give a clear enough picture of the heart valves’ condition. It can clearly show the anatomy of the heart’s valves, be used to assess the severity of any narrowing or leakage of the valves, and to determine if there are any lesions or nearby tumors affecting the heart. The Heart Institute uses some of the most advanced CT imaging available, including the Aquilion CFX Series Volumetric Cardiac CT.

Magnetic resonance imaging (MRI) uses powerful magnet and radio waves to make detailed images of the heart. Cardiac MRI can be used to get a more detailed look at suspected valve problems, or be used by your surgeon to plan for the surgery.

Cardiac catheterization is a minimally invasive technology where a flexible tube is introduced into a blood vessel in your arm, groin, or neck and threaded to your heart, guided by x-ray images. Your physician conducts tests through the catheter to measure blood pressure within the heart, evaluate heart muscle function, and observe whether the heart’s valves are opening and closing fully and efficiently. Catheterization may be used when other test results are inconclusive, or more detailed information is needed. Treatment protocols can also be performed during catheterization for some conditions.

In few areas of medicine have advances in technology made more of a life-saving difference than in cardiac care. St. Helena Hospital has long been a pioneer in bringing cutting edge technology to cardiac care, and the Heart Institute’s state-of-the-art non-invasive cardiac diagnostic center offers a full range of diagnostic services, brought to you by some of the most experienced and highly trained cardiac specialists in the West.

After diagnosis, what?

Most valve disease can be successfully treated, including cases that were considered untreatable even a few years ago. The Valve Clinic offers a full range of cutting-edge treatment options for all levels of valve disease, including complex multifaceted cardiac conditions and other challenging cases.