To diagnose aortic valve stenosis, your doctor will review your signs and symptoms, discuss your medical history, and do a physical examination. He or she will listen to your heart with a stethoscope to determine if you have a heart murmur that may signal an aortic valve condition.
Your doctor may order several tests to confirm or rule out aortic valve stenosis. Tests also can help determine a cause and the condition's severity.
Tests for aortic valve stenosis may include:
Echocardiogram. This test uses sound waves to create images of your heart in motion. A technician presses a device (transducer) firmly against your skin, aiming an ultrasound beam through your chest to your heart. The transducer records the sound wave echoes from your heart, and a computer converts the echoes into images that your doctor can view on a monitor.
An echocardiogram can show your doctor how blood flows through your heart and heart valves. It can help identify a weakened heart muscle and determine the severity of aortic valve stenosis.
If your doctor needs a closer look at your aortic valve, a transesophageal echocardiogram may be done. In this test, a flexible tube containing the transducer is guided down your throat and into your esophagus.
- Electrocardiogram (ECG or EKG). This painless test detects and records your heart's electrical activity using small sensors (electrodes) attached to your chest and arms and, sometimes, legs. An EKG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
- Chest X-ray. A chest X-ray can help your doctor determine whether your heart is enlarged, which can occur in aortic valve stenosis. It can also show swelling of the aorta and calcium buildup on your aortic valve.
- Exercise tests or stress tests. Exercise tests help your doctor determine whether signs and symptoms of aortic valve disease occur during physical activity. These tests can help determine the severity of your condition. If you are unable to exercise, medications that have similar effects as exercise on your heart may be given to complete the test.
- Cardiac computerized tomography (CT) scan. A cardiac CT scan combines several X-ray images to provide a more detailed cross-sectional view of the heart. Doctors may use cardiac CT to measure the size of your aorta and look at your aortic valve more closely.
- Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and evaluate the size of your aorta.
Cardiac catheterization. This test isn't often used to diagnose aortic valve disease, but it may be used if other tests aren't able to diagnose the condition or to determine its severity. It may also be used before aortic valve surgery to make sure the arteries that feed the heart muscle (coronary arteries) are not blocked.
In this procedure, your doctor threads a thin tube (catheter) through a blood vessel in your arm or groin and guides it to an artery in your heart.
Sometimes, dye is injected through the catheter to help your arteries show up more clearly on an X-ray (coronary angiogram). A coronary angiogram gives your doctor a detailed picture of your heart arteries and how your heart functions. During the test, your doctor can also measure the pressure inside your heart chambers.
Treatment for aortic valve stenosis depends on your signs and symptoms and the severity of the condition.
If you have mild symptoms or none at all, you may only need to have your condition monitored with regular doctor's appointments. Your doctor may recommend healthy lifestyle changes and medications to treat symptoms or reduce the risk of complications.
Surgery or other procedures
You may eventually need surgery to repair or replace the diseased aortic valve, even if you don't have symptoms. Aortic valve surgery may be done at the same time as other heart surgery.
Surgery to repair or replace an aortic valve is usually done through a cut (incision) in the chest. Less invasive approaches may be available. Ask your doctor if you're a candidate for these procedures. Aortic valve surgery may be done at the same time as other heart surgery.
Surgery options for aortic valve stenosis include:
- Aortic valve repair. To repair an aortic valve, surgeons separate valve flaps (cusps) that have fused. However, surgeons rarely repair an aortic valve to treat aortic valve stenosis. Generally aortic valve stenosis requires aortic valve replacement.
Balloon valvuloplasty. This procedure can treat aortic valve stenosis in infants and children. However, the valve tends to narrow again in adults who've had the procedure, so it's usually only done in adults who are too ill for surgery or who are waiting for a valve replacement, as they typically need additional procedures to treat the narrowed valve over time.
In this procedure, a doctor inserts a long, thin tube (catheter) with a balloon on the tip into an artery in your arm or groin and guides it to the aortic valve. Once in place, the balloon is inflated, which widens the valve opening. The balloon is then deflated, and the catheter and balloon are removed.
Aortic valve replacement. Aortic valve replacement is often needed to treat aortic valve stenosis. In aortic valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Biological tissue valves break down over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve.
Transcatheter aortic valve replacement (TAVR). This less invasive procedure may be an option for people who are considered to be at intermediate or high risk of complications from surgical aortic valve replacement.
In TAVR, doctors insert a catheter in your leg or chest and guide it to your heart. A replacement valve is then inserted through the catheter and guided to your heart. A balloon may expand the valve, or some valves can self-expand. When the valve is implanted, doctors remove the catheter from your blood vessel. Doctors may also perform a catheter procedure to insert a replacement valve into a biological tissue valve that is no longer working properly.
Lifestyle and home remedies
You'll have regular follow-up appointments with your doctor to monitor your condition. You'll need to continue taking all your medications as prescribed.
Your doctor may suggest that you incorporate several heart-healthy lifestyle changes into your life, including:
- Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
- Maintaining a healthy weight. Aim to keep a healthy weight. If you're overweight or obese, your doctor may recommend that you lose weight.
- Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine.
- Managing stress. Find ways to help manage your stress, such as through relaxation activities, mindfulness, exercise, and spending time with family and friends.
- Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.
For women with aortic valve stenosis, it's important to talk with your doctor before you become pregnant. Together, you and your doctor can discuss which medications are safe to take during pregnancy, and whether you may need a procedure to treat your valve condition before getting pregnant.
You'll likely require close monitoring by your doctor during pregnancy. Doctors may recommend that women with severe valve stenosis avoid pregnancy to avoid the risk of complications.
Preparing for your appointment
If you think you have aortic valve stenosis, consider being evaluated and treated at a medical center with a multidisciplinary team of cardiologists and other doctors and medical staff trained and experienced in evaluating and treating heart valve disease.
Here's some information to help you prepare for your appointment.
What you can do
- Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do beforehand.
- Write down your symptoms, including any that seem unrelated to heart valve disease.
- Write down key personal information, including a family history of heart disease and any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements you take.
- Take a family member or friend along, if possible. Someone who accompanies you can help you remember information you receive.
- Be prepared to discuss your diet and exercise habits. If you don't already eat well and exercise, be ready to talk to your doctor about challenges you might face in getting started.
- Write down questions to ask your doctor.
For aortic valve stenosis, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What tests will I need?
- What's the best treatment?
- What are the alternatives to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- If I need surgery, which surgeon do you recommend for heart valve surgery?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed material I can take with me? What websites do you recommend?
Don't hesitate to ask other questions you have.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did your symptoms begin?
- Do you always have symptoms or do they come and go?
- How severe are your symptoms?
- What, if anything, improves your symptoms?
- What, if anything, worsens your symptoms?