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Diagnosis

Diagnosis

Heart valve disease is a treatable condition if diagnosed early. If you are over 65 or think you may have any of the symptoms of heart valve disease, ask your GP for a check-up.

Stethoscope check

Diagnosis starts with a simple step – listening to the heart with a stethoscope. To diagnose heart valve disease, the doctor needs to use a stethoscope to listen for the characteristic heart “murmur” or “click-murmur” which is usually the first indication of a heart valve disorder.

Further investigation

Further diagnostic tests can then be undertaken, ranging from electrocardiography (recording the heart’s electrical activity), through to echocardiography (ultrasound of the heart). These and other more sophisticated diagnostic tests allow doctors to make a more accurate diagnosis of heart valve disease and determine the level of severity.

Electrocardiography

This simple test records the heart's electrical activity via electrodes attached to the skin. It is the most direct way to assess the rhythm of the heart. The electrical impulses are recorded in the form of waves on graph paper.

Chest X-Ray

This reveals general information about the size and shape of the heart. If a heart becomes enlarged due to valve disease it, will assume different shapes depending on the particular valve disorder.

Echocardiography and Doppler Echocardiography

This painless, non-invasive test is used routinely to diagnose valve abnormalities. Ultrasound equipment takes images of the heart while it's beating, providing a view of blood flow through the heart and identifying areas of regurgitation, if present.

Radionuclide Ventriculography

A nuclear scanning method, this tests injects a small amount of radiation into the body via the bloodstream. The radiation is monitored while the patient is at rest and during exercise, providing information about the heart muscle and blood flow, as well as the size and shape of the heart's pumping chambers (ventriculi).

Cardiac Catheterisation

Catheters are inserted into a vein and an artery to help determine the function and condition of the heart, valves and coronary arteries. It is the only test that can provide an accurate "road map" of the coronary arteries.

Transoesophageal Echo

Passing a probe down the oesophagus provides an image of the heart from behind. This test may be used both prior to and during surgery to accurately show valve regurgitation.


However, there are many challenges faced at all stages of care around the diagnosis and management of patients with heart valve disease. Some of the challenges include:

Infrequency of presentation

It is a challenge for GPs in primary care to identify patients for treatment and refer them. This is due to the relative infrequency with which GPs see heart valve disease cases, meaning this is not necessarily at the forefront of their diagnostic skills set.

Difficult symptoms to identify

Some patients are asymptomatic – but many patients, who say they have no symptoms, do have symptoms on objective testing – it is difficult for physicians in both primary and secondary care to detect and correctly diagnose heart valve disease.

Infrequent use of stethoscopes

A recent survey suggests that stethoscopes are infrequently used by physicians in primary care to listen to a patient’s heart when they present with potential symptoms of heart valve disease – the one key action that could potentially detect heart valve disease.

Late diagnosis

Patients are not being diagnosed early enough – they are ‘slipping through the net’ at all stages of the treatment pathway; in primary care and within secondary care due to lack of education, awareness and incorrect referrals.

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