Tests and diagnosisBy Mayo Clinic staff
If you develop signs or symptoms of mitral valve stenosis — for example, if you are suddenly breathless with mild exertion — your doctor may ask you to undergo several types of diagnostic tests.
But first your doctor will ask about your medical history and give you a physical examination. As part of your examination, he or she listens carefully to your heart through a stethoscope. Mitral valve stenosis causes an abnormal heart sound, called a heart murmur. A narrowed mitral valve can make a distinct snapping sound followed by a rumbling murmur.
In addition to listening to your heart, your doctor listens to your lungs and the sounds of your breathing. Your doctor is checking for lung congestion — the buildup of fluid in your lungs — that can occur with mitral valve stenosis.
From the initial results, your doctor decides which tests are needed to make a diagnosis. For testing, you may be referred to a cardiologist.
Common tests to diagnose mitral valve stenosis include:
- Echocardiogram. This test uses sound waves to produce an image of your heart. In an echocardiogram, sound waves are directed at your heart from a wand-like device (transducer) held on your chest. Sound waves bounce off your heart and are reflected back through the chest wall and processed electronically to provide video images of your heart in motion. An echocardiogram helps your doctor closely examine the mitral valve. The image shows the structure of the mitral valve and how it moves during the beating of your heart.
- Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. An ECG can give information about your heart rhythm and, indirectly, heart size. With mitral valve stenosis, some parts of your heart may be enlarged and you may have atrial fibrillation, a heart rhythm irregularity. Your doctor may ask you to walk on a treadmill or pedal a stationary bike while undergoing an ECG, to see how your heart responds to exertion.
- Holter monitoring. A Holter monitor is a portable device that you wear to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect intermittent heart rhythm irregularities that may accompany mitral valve stenosis.
- Chest X-ray. An X-ray image of your chest allows your doctor to check the size and shape of your heart to determine whether the left atrium is enlarged - a possible indicator of mitral valve stenosis. A chest X-ray also helps your doctor check the condition of your lungs. Mitral valve stenosis may lead to blood backing up in your lungs, which causes congestion that's visible on an X-ray.
- Transesophageal echocardiogram. This type of echocardiogram allows an even closer look at the mitral valve. Your esophagus, the tube that runs from your throat to your stomach, lies closely behind your heart. In a traditional echocardiogram, a transducer is moved across your chest. In a transesophageal echocardiogram, a small transducer attached to the end of a tube is inserted down your esophagus. Because your esophagus lies close to your heart, having the transducer there provides a clearer picture of the mitral valve and blood flow through it.
- Cardiac catheterization. In this procedure, your doctor threads a thin tube (catheter) through a blood vessel in your arm or groin to an artery in your heart. A dye injected through the catheter fills your heart's arteries, and the arteries become visible on an X-ray. This test gives your doctor detailed information about the condition of your heart. Some catheters used in cardiac catheterization have miniature devices (sensors) at the tips that can measure pressure within heart chambers, such as the left atrium.
Cardiac tests such as these help your doctor distinguish mitral valve stenosis from other heart conditions, including other problems of the mitral valve. Mitral regurgitation is a condition in which the mitral valve doesn't close tightly. Mitral valve prolapse is a disorder in which the mitral valve sags instead of closing tightly. These conditions may also require treatment.
If you receive a diagnosis of mitral valve stenosis, these tests also help reveal the cause, determine how serious the problem is, and determine whether the mitral valve can be repaired or if replacement may be necessary.
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