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How is aortic stenosis diagnosed?

Dr. Mark J. Russo, MD
Cardiothoracic Surgeon

Persons with AS often have no symptoms, but detection of a murmur may be discovered during a routine examination.

AS may be detected by listening with a stethoscope revealing a murmur. 

In addition to a complete medical history and physical examination, diagnostic procedures for AS may include any, or a combination, of the following:

  • electrocardiogram (ECG or EKG): a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage. 
  • echocardiogram (Echo): a noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. Echocardiography is the most useful diagnostic test for AS. 

In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Additional procedures may include:

  • stress test (treadmill or exercise ECG): a test that is performed while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored.
  • cardiac catheterization: with this procedure, x-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions and other abnormalities of specific arteries. In addition, the function of the heart and the valves may be assessed. 
  • cardiac MRI: this is a noninvasive test that produces comprehensive images of the heart. It may be used as a complement to an echo for a more precise look at the heart valves and heart muscle, or in preparation for heart valve surgery.

 

Aortic stenosis (AS) may be diagnosed using one or more of the following tests:

  • 12-lead ECG (or EKG): An ECG helps healthcare providers look for damage or problems in different areas of the heart. Your skin may need to be prepared with cleaning or hair removal. Sticky pads are placed on your chest, arms and legs. Each sticky pad has a wire that is attached to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Healthcare providers will look closely for certain problems or changes in how your heart is working. This test takes 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  • Cardiac catheterization: This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
  • Chest x-ray: This is a picture of your lungs and heart. Healthcare providers use it to see how your lungs and heart are doing. Healthcare providers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs or fluid around the heart and lungs.
  • Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement and blood vessels of your heart.
Dr. Abdul J. Tajik, MD
Cardiologist (Heart Specialist)

To diagnose aortic stenosis, your health care provider will record a medical history, asking questions about your symptoms, past medical problems and family history of heart problems. A physical examination also will be completed. Patients with aortic stenosis often have a heart murmur, which occurs because of turbulent blood flow as it passes the obstructed valve opening.

The following tests are commonly ordered:

  • Transthoracic Echocardiogram (TTE): Ultrasound is used to show pictures of the heart. The ultrasound probe is placed in different positions on your chest. This test provides information on the valve’s structure and function, chamber size, pressures inside the heart and heart muscle function. This is the best way to evaluate your aortic valve.
  • Transesophageal Echocardiogram (TEE): If additional information is needed, a TEE can be performed. The ultrasound is lowered into the esophagus to show detailed images of your heart and aorta. This test requires you take medication to make you sleepy and relaxed.
  • Exercise Echocardiogram: This test requires you to walk on a treadmill. When you have walked as much as you can tolerate, you will quickly lie on the bed and have additional echocardiography images taken to evaluate your heart’s response to stress.
  • Chest X-ray: This shows the size and position of your heart and any abnormalities in the lungs.
  • Electrocardiogram (ECG): An ECG measures the electrical activity of your heart. It provides information about the heart rhythm and indirectly measures the heart.
  • Holter Monitor: This portable monitor is worn for 24-72 hours. Leads are placed on your chest that cannot be removed during the test. You will write down any symptoms you have so they can be compared to the heart rhythm at that time. This test may be ordered if you are experiencing dizziness, syncope or palpitations.
  • Cardiac Computed Tomography Angiography (CTA):  This test uses CT technology to determine whether coronary arteries and other major blood vessels have blockages or narrowed areas.
  • Cardiac Magnetic Resonance Imaging (MRI): An MRI uses magnetic fields and radio waves to create pictures of your heart.
  • Heart Catheterization: A catheter is placed in your groin and another is passed through your artery to the heart. Dye can be distributed through the catheter to determine whether you have any blockages in the arteries that supply blood to your heart. The catheter also can be used to measure pressures in your lungs and inside the heart.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.