• The symptoms described by the patient will be very important, and the diagnosis will be supported by a murmur heard when the chest is examined. These heart murmurs vary in character, site and intensity, and provide much information on the state of the valve.
• A chest x-ray will show whether there is enlargement of the heart or congestion of the lungs.
• An ECG will give an overall indication of the state of the heart muscle, and will also diagnose any rhythm disturbances, which are a common complication of valve disease.
• The definitive investigation is the echocardiogram. This is a "real-time" ultra-sound, which shows the heart contracting and the valves opening and closing as it happens. An external echocardiogram can be done in the cardiologist’s rooms by a specially trained technician. A far better and more accurate kind, however, is a trans-oesophageal echocardiogram, or TEE. This is also a real-time ultrasound, but is done with the patient anaesthetised via a special probe that he/she swallows (very much like a gastroscopy). Very clear pictures and accurate measurements of blood flow and valve anatomy and function provide valuable information used in deciding on the best treatment for the patient.
• An angiogram may be recommended to examine the state of the coronary arteries if the ECG indicates there is concurrent arterial disease.
Reviewed by Dr A.G. Hall (B.Soc.Sc.(SW), MB,Ch.B)
December 2008