A patient’s diagnosis with heart valve disease

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I met a lovely lady in pre-assessment clinic at St Thomas’ hospital. Lily* is a very fit lady, in her mid-60s, who with hindsight first noticed pain in the left side of her jaw while running marathons a year ago.

She developed a virus in January this year and was unable to run in the London marathon. She continued to do regular Park Runs, however she was becoming more short of breath when running and her times, which had been very competitive, were increasing. Lily initially put this down to her age. She developed a cough and consulted her GP who listened to her chest with a stethoscope, noticed a heart murmur and referred her for tests, including an echocardiogram (specialist ultrasound looking at heart valves). This showed that Lily has severe aortic stenosis.

Lily’s GP referred her to a Consultant Cardiologist who assessed her, and explained that she would require an operation to replace her aortic valve to solve this. Additionally, an extra test would be needed before she was seen by a Consultant Surgeon, a coronary angiogram, a specialised procedure, carried out by a Cardiologist whereby radio opaque dye is injected to the coronary arteries and imaging is recorded. This is to check for any blockages or narrowing in the coronary arteries which would require treatment at the same time as the aortic valve surgery. The Consultant advised Lily that her coronary arteries were normal. She was pleased with this as she has looked after herself, is very fit, normal weight and never smoked.

At her pre-assessment clinic appointment Lily described her current symptoms which included occasional chest pain, some shortness of breath on walking on inclines, intermittent dizziness after a long run and on standing up quickly, from sitting. She told us that she was still competing in Park Runs and was really keen to remain active and continue this. All her observations and blood tests were within the normal range. Lily had another echocardiogram at St Thomas’ which confirmed severe aortic stenosis and an electrocardiogram (ECG) which showed a slow normal heart rate, often associated with athletes.

Lily saw the Consultant Surgeon who explained in detail that she would require aortic valve surgery to enable her to return to her formal fitness, relieve her symptoms and protect her in the future. He talked her through the procedure, types of valves, expected recovery time in hospital and at home. Lily signed the first part of the consent form for aortic valve replacement, choosing a tissue valve. She asked if she could continue the Park Runs and was advised that she could continue running gently or walking the course, as long as she did not develop further symptoms. These include: chest pain, increased shortness of breath, dizziness and or fainting. They are an indication of worsening valve disease. If this happens she was advised to inform us or in an emergency, call an ambulance.

She went home with information on having heart surgery and my contact details for any further questions.

In my next blog I will talk about Lily’s post-operative journey.

You can find out more information about heart valve disease on the Heart Valve Voice website which I support in various projects.

*The name used in this blog has been substituted for confidentially reasons – I refer to the patient here as Lily.

 

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