The diagnosis of valvular stenosis will begin with the physician obtaining the patient’s medical history and performing a physical examination. As part of the physical examination, the physician will listen to the patient’s heart through a stethoscope. Telltale murmurs can indicate the location and nature of some valve diseases, such as aortic stenosis – a condition in which the sound of the blood flow through the damaged valve is turbulent and distinctive. The sounds of mitral stenosis, tricuspid stenosis and pulmonic stenosis have their own distinctive characteristics.

As part of the physical examination, the physician will also listen for lung congestion and assess for the presence of edema. An abnormal pulse will confirm the presence of an abnormal heart rhythm (arrhythmia).

The next diagnostic step typically will be an electrocardiogram (EKG). This is a recording of the heart’s electrical activity as a graph on a moving strip of paper or video monitor. The highly sensitive electrocardiograph machine helps detect heart irregularities, disease and damage by measuring the heart’s rhythms and electrical impulses. This test can indicate if any of the heart’s chambers are enlarged (the left ventricle in particular) and if arrhythmias are occurring.

If the patient’s history, physical examination and EKG suggest the presence of valvular stenosis, then additional tests will be ordered. Noninvasive tests include:

• Chest x-ray. A radiation-based imaging test that offers the physician a picture of the general size, shape, and structure of the heart and lungs. An enlarged heart can indicate damage or dysfunction, while congestion of the lungs may indicate heart failure.
  
  
• Exercise stress test. An EKG is performed while the patient exercises in a controlled manner on a treadmill or stationary bicycle at varied speeds and elevations. The reaction of the heart under exertion can be measured and evaluated, and the functional significance of the valvular stenosis can be assessed.

If these noninvasive tests do not offer enough information, an invasive procedure called a cardiac catheterization may be done. During the cardiac catheterization, pressures will be measured to determine the severity of the stenosis. To measure pressures in different chambers and structures of the heart, catheters may be guided into different areas of the heart. For instance, with aortic stenosis, catheters may be used to measure and compare blood pressure in the left ventricle versus the aorta. Because of the narrowed aortic valve, the blood pressure is higher in the left ventricle.

Newer approaches being developed include special CT scans in which multiple images (multi-slices) can obtain actual images of the heart valves and are able to measure actual opening dimensions of the stenosis.

A coronary angiogram may also be done to ensure that the coronary anatomy is normal. To perform this test, the physician injects a special dye (contrast medium) that is visible to x-ray into the coronary arteries through a catheter inserted into the coronary arteries. Then the coronary angiogram can be taken. Following the coronary angiogram, a left ventricular angiogram will be performed.

If significant narrowing of the coronary arteries is found, physicians may correct this situation by placing bypass grafts at the same time as surgery for the stenotic valve.