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Diagnosing Aortic Stenosis: ECG, Echocardiogram, and More

Medically reviewed by Colleen O’Brien-Podulka, CRNP
Written by Maureen McNulty
Posted on December 8, 2023

  • Almost half of adults in the United States have some form of heart disease.
  • Diagnostic tests can identify heart problems such as aortic stenosis.
  • The severity of aortic stenosis is measured to determine the treatment plan.

In the United States, nearly half of adults have some form of heart disease. These conditions lead to problems with the heart muscle, electrical system of the heart, blood vessels, or — in the case of aortic stenosis — the heart valves. Heart conditions can lead to many overlapping symptoms, so how do you know which type you have?

Many diagnostic tests can help your doctor determine whether you have heart problems and, if so, which condition may be the culprit. These tests help your doctor see what your heart looks like and identify any abnormalities.

The aortic valve is the opening that controls blood flow from your heart into your aorta, the artery that carries blood to the rest of your body. Aortic stenosis (also called aortic valve stenosis) is a condition that affects your aortic valve. If you have aortic stenosis, your aortic valve may become too narrow, causing your heart to work harder to pump out blood. Eventually, heart failure can occur. Diagnostic tests can help your doctor visualize whether your aortic valve looks normal, measure how well it works, and see whether your heart is as strong as it needs to be.

Tests for Aortic Stenosis

Your doctor may order multiple tests if you are experiencing symptoms of aortic stenosis or if your health care team thinks that your heart is not functioning as it should. These tests may help diagnose aortic stenosis or rule out other heart issues.

Physical Exam

Many people first find out they have a heart valve problem during a regular physical examination. During this time, your doctor typically places a stethoscope at different points on your chest and back to listen to the sounds your heart makes. Aortic stenosis and other conditions that affect your heart valve often produce a heart murmur — an unexpected swishing or whooshing sound that your heartbeat makes.

During a typical physical exam, your doctor may also perform other tests such as taking your blood pressure, measuring your pulse, and listening to your lungs. These tests may provide clues when your heart isn’t working as it should.

Your doctor will also typically ask you questions to learn more about your heart health. They could ask about any possible symptoms related to heart disease, such as chest pain or shortness of breath. They may also inquire about risk factors for aortic stenosis or other conditions. Significant symptoms of aortic stenosis include chest pain, shortness of breath, or fainting.

Based on the results of your physical exam, your doctor might recommend various heart tests or follow-up appointments with a cardiologist.

Chest X-Ray

A chest X-ray is often recommended for people with symptoms of heart disease. For example, it may be used to determine if a symptom like shortness of breath is related to a heart or lung problem. This test captures a picture of your heart and lungs and can provide clues about potential problems.

Chest X-rays may appear completely normal for people with early-stage aortic stenosis if the condition isn’t yet severe enough to cause damage. However, for those with more advanced aortic stenosis, a chest X-ray may show that the heart is enlarged, the aorta is bigger than it should be, or there is calcification (a buildup of calcium in the valve).

Echocardiogram

If there are any signs that you may have a valvular heart disease, your doctor will likely recommend an echocardiogram, as this is the main test used to diagnose aortic stenosis.

An echocardiogram helps your doctor visualize your heart. It sends painless sound waves into your chest, which bounce off your tissue to form a picture of your heart’s structure. Your doctor can use this test to determine if blood isn’t flowing normally through your heart valves and measure how strong your heart is.

To best assess your aortic valve, your cardiologist may recommend a special kind of echocardiogram known as a transesophageal echocardiogram (TEE). During this procedure, a health care provider will pass a device down your throat and into your esophagus (the tube that leads to your stomach) to get the device as close as possible to your heart and produce a clearer image.

Electrocardiogram

Your doctor may recommend an electrocardiogram — also called an ECG or EKG — to look at the electrical signals that control your heartbeat. This test shows if your heart is beating too fast, too slow, or abnormally.

An electrocardiogram can’t directly diagnose aortic stenosis. However, your doctor may still want you to get this test because it can provide other information about the health of your heart and diagnose related conditions such as coronary artery disease, which often occurs alongside aortic stenosis.

Other Imaging Tests

While a chest X-ray can provide a basic picture of your heart, other imaging tests can produce a more detailed view. Your doctor may use these tests to learn more about your aortic valve disease.

A cardiac CT scan is a technique in which many X-rays of your heart are taken in rapid succession and combined with a computer to form a more precise image. A cardiac MRI creates pictures using other techniques, including radio waves and magnets. These imaging tests may help your doctor measure the size of your aorta, which could be enlarged if you have aortic stenosis.

Stress Tests

Stress tests may be used if other heart test results aren’t clear or if your doctor wants to see whether you have additional symptoms when your heart beats faster.

To perform a stress test, you may have to exercise by walking on a treadmill or riding a stationary bike. Alternatively, your doctor may give you a dose of medication like dobutamine (Dobutrex), which increases your heart rate. Your doctor can then measure how well your heart works as it beats quickly.

Cardiac Catheterization

The above tests are usually enough to diagnose aortic stenosis. However, if the results are inconclusive (do not provide a clear answer), you may need to undergo cardiac catheterization. This test provides another way of measuring your heart function.

During cardiac catheterization, your doctor inserts a narrow tube into an artery in a more distant location, such as your wrist or groin, and navigates it toward your heart, where IV contrast dye is used to visualize the blood vessels that supply blood to your heart muscle. Heart pressures can be measured to determine if the aortic valve is narrowed.

Measuring the Severity of Aortic Stenosis

Following a diagnosis of aortic stenosis, your doctor may also use tests to determine how severe your condition is. Your disease severity helps determine which treatment plan is best for you.

The primary test used to stage aortic stenosis is a type of echocardiography called quantitative Doppler echocardiography. This test is routinely performed during a standard echocardiogram and measures three different factors that help your doctor determine the overall severity:

  • Peak aortic jet velocity or Vmax — How fast blood flows through your aortic valve
  • Mean pressure gradient or Pmean — How much higher your blood pressure is within your left ventricle (one of the chambers of your heart) compared to within your aorta
  • Aortic valve area or AVA — The diameter of your aortic valve

Based on these measurements, your doctor can determine whether you have mild, moderate, or severe aortic stenosis.

The outcomes of these tests are vital in figuring out the right treatment and how to manage aortic stenosis. It’s essential to consult with a cardiologist for a thorough evaluation and diagnosis to make sure to get the proper care.

Talk With Others Who Understand

On MyHeartDiseaseTeam, the social network for people with heart disease and their loved ones, more than 59,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Have you been diagnosed with aortic stenosis? Have you undergone an aortic valve replacement procedure? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on December 8, 2023
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Colleen O’Brien-Podulka, CRNP . Learn more about her here
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here

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