Health

The simple stethoscope test that spots a silent killer

When Labour MP Stephen McCabe was told he had a heart murmur that needed attention ‘very urgently’, his initial response was to dismiss the advice.

It had been spotted during a routine medical at Westminster, and Stephen, then 56, admits his first thought was: ‘Don’t be silly. Everything else came back perfect: there’s nothing wrong with me.’

Mulling over the advice that evening, however, he realised his ‘stupidity’ and decided to seek help. Within a month, he’d been diagnosed with heart valve disease.

‘By then, I’d realised this was pretty serious, as the cardiologist said I was at risk of a heart attack or worse,’ he says.

When Labour MP Stephen McCabe was told he had a heart murmur that needed attention ‘very urgently’, his initial response was to dismiss the advice

The problem was his mitral valve, which lies between the heart’s upper left chamber (left atrium) and the lower left chamber (left ventricle). 

The ‘flaps’ that make up the valve were not closing properly, so blood was leaking back to the left atrium — a condition known as mitral valve regurgitation.

Left untreated, this can cause heart rhythm problems, high blood pressure, fluid in the lungs and heart failure, where the heart cannot pump enough blood around the body. Around one in five such patients will die within five years.

‘It is a slow but progressive decline, with increasing hospitalisation, usually due to heart failure,’ explains Professor Richard Anderson, a consultant interventional cardiologist at the University Hospital of Wales in Cardiff.

Heart valve disease can be diagnosed with a stethoscope by the GP — yet, astonishingly, these checks are not routinely performed, according to the charity Heart Valve Voice

Heart valve disease can be diagnosed with a stethoscope by the GP — yet, astonishingly, these checks are not routinely performed, according to the charity Heart Valve Voice

Thankfully, Stephen was diagnosed early enough to have an operation to repair his defective valve. In fact, that medical probably saved his life because, like many people with heart valve disease, he didn’t have any obvious symptoms (common ones include fatigue, breathlessness, chest pains and abnormal heart beats).

Some are not so lucky.

Stephen recognises, with hindsight, that he’d had episodes of tiredness and shortness of breath, but he’d put these down to a heavy work schedule or getting older.

Around 1.5 million Britons over 65 have some form of heart valve disease. Most deaths occur either because patients don’t have symptoms or because they attribute them to ‘getting older’.

There are four valves in the heart, but it’s the two on the left side — the mitral and aortic valves — that are most commonly damaged or affected by disease. This is thought to be because there’s much more pressure on the left side, as it pumps blood around the body.

Damage can occur for a number of reasons, including following another illness, for instance rheumatic fever or infective endocarditis. Very rarely, it’s passed on genetically. But the number one risk factor is age.

The most common type of heart valve disease is aortic stenosis, when the aortic valve separating the lower heart chamber (ventricle) from the aorta (the body’s main artery that delivers blood to the body) becomes calcified or hardened with age. This narrows the opening through which blood can flow through the valve.

This narrowing means increased pressure is needed within the heart to pump blood out. Eventually, it reduces the heart’s ability to pump blood, leading to heart failure. Untreated, half of patients will die within two years.

‘Breathlessness gets worse, fluid collects on the lungs and death follows with the patient almost drowning in this fluid,’ explains Professor Anderson.

‘Or they die suddenly at home when the heart slows down and fails within a couple of hours. It’s more deadly than most cancers in that respect. Many patients die while waiting for surgery.’

Around 1.5 million Britons over 65 have some form of heart valve disease. Most deaths occur either because patients don’t have symptoms or because they attribute them to ‘getting older’

Around 1.5 million Britons over 65 have some form of heart valve disease. Most deaths occur either because patients don’t have symptoms or because they attribute them to ‘getting older’

Heart valve disease can be diagnosed with a stethoscope by the GP — yet, astonishingly, these checks are not routinely performed, according to the charity Heart Valve Voice, which, backed by Stephen McCabe, is now calling for annual stethoscope tests for all over-65s.

During this test, doctors listen to the sound of the blood flow at various points around the chest, looking out for abnormal sounds or ‘murmurs’ which may indicate blood is flowing at abnormally high pressure or speed.

Once detected, treatment may involve blood pressure drugs to open the arteries, blood thinners to reduce the chance of blood clots and beta blockers to slow the heart down.

But the only way to treat the underlying disease is surgery: either valve repair or valve replacement. There are different types of repair operations, such as tightening the flaps to reduce leakage, replacing the cords that support the valve, or removing excess tissue so that the valve can close tightly.

Valve replacement involves replacing the diseased valve with an artificial one or one made from animal tissue. This often involves open heart surgery, which is too gruelling for older patients.

Less invasive procedures are also becoming more available. For example, the Mitraclip, which was approved by NICE in 2019, repairs the valve using a tube threaded through the groin. The paperclip-like device holds the defective valve flaps together, helping to restore normal blood flow through the heart.

Stephen, who represents Selly Oak in Birmingham, believes his lifestyle may have contributed to his heart valve condition. ‘Being an MP, I cannot claim to have the healthiest lifestyle in the world,’ he says. He had smoked until 2009 and was overweight.

Following his diagnosis in October 2011, Stephen, who is divorced with two grown-up children and lives with his partner, Fiona, realised he couldn’t take his health for granted any longer.

Further tests at Queen Elizabeth Hospital, Birmingham, including an ultrasound of the heart, revealed his heart was working harder than it should.

‘With medication alone, the risk was that my heart would deteriorate and I’d have a heart attack.’ The alternative was surgery to repair the defective valve.

He underwent open heart surgery in May 2012. Normally this procedure takes two to four hours, but Stephen’s was more complicated — he doesn’t know why — and took seven.

He says that when he came round: ‘I couldn’t work out if I was dreaming or had died. I felt like I’d been kicked by a horse.’

But he made progress in the days that followed and was allowed home a week later. Even so, he found his recovery to be slow and, at times, demoralising.

‘Psychologically, I felt much worse after the surgery than before — very down in the dumps,’ he says. ‘I convinced myself I’d never get back to normal and would have to give up my job.’

It would be two months before he felt up to taking short walks — and a turning point came six weeks later when he started going to exercise classes at a rehabilitation centre.

Four months after the operation, he was well enough to do some work from home, and he returned to Westminster early in 2013.

‘I felt a million times better, and every week I felt stronger,’ he says.

These days he only takes low doses of a blood pressure drug. Regular check-ups have shown the surgery to be a success.

He says: ‘I know first-hand the importance of receiving timely treatment. With early diagnosis and proper treatment, these conditions aren’t debilitating.’

heartvalvevoice.com

Storing up trouble 

What’s the healthiest way to store your food? This week: Filtered or bottled water.

Some people use water filtering jugs to remove the taste of chlorine, but in doing this you also remove the bacteria-killing abilities of that chlorine. 

For this reason, you should refrigerate it and drink it within 24 hours, according to experts at Water UK, an industry group representing the UK’s water suppliers.

Dr Edward Fox, an expert in food safety at Northumbria University, suggests doing the same with bottled water. 

‘Once you open a water bottle, there is a risk for contamination with microbes. So, in general for waters, once opened they should be refrigerated to help keep them safe.’

Jargon Buster 

Medical terms decoded. This week: Metastatic

Metastatic refers to a disease spreading from its origin in the body. It is generally used to describe cancer that has spread to another part of the body.

But it is also used for infections, including those caused by bacteria such as staphylococcus aureus, that have travelled from the area where the infection first started.

Metastatic infections can result in serious conditions such as infective endocarditis — which affects the lining of the chambers of the heart and is usually caused by bacteria that travels from the mouth.

In metastatic cancer, the cancer cells break away from where they formed and travel elsewhere in the body, usually via the blood or lymph system. 

A metastatic cancer is the same type as the original. So, if breast cancer cells spread to the lung, they are still breast cancer cells not lung cancer.


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