As GPs we need to remain aware of aortic valve and aortic disease as it can lead to premature death. Cardiac surgery can help prolong life and as we might be the first port of call for patients and therefore key to prompt referral.
We are super busy and multi-tasking within our 10-minute appointments, but we can remind ourselves, amid all the work, to go back to basics. Listen to our patients and listen to their hearts.
A fantastic GP did just that when a relative of mine went to see them for a check-up before a marathon. The GP listened to his heart, and picked up a murmur due to a leaking aortic valve. He had corrective surgery and he’s recently climbed Ben Nevis.
If a patient has a first-degree relative with a bicuspid aortic valve, there is a 10% risk that they could have the same. Consider a referral for echocardiography with this family history. Aortic pathology can be due to congenital abnormalities like this, but more commonly from age related calcification, and infective or rheumatic damage. As our population ages and we live longer, calcification is taking over as the main causative factor.
Aortic valve disease affects 13% of the over 75s. If an adult patient presents with exertional symptoms such as chest pain, breathlessness, dizziness or syncope, remember your basics and auscultate the heart for a murmur. Include an auscultation in your routine elderly checks.
A patient has a much greater chance of doing well if the problem is picked up as a heart murmur with no symptoms. Consider rheumatic disease in patients from places where this is still very prevalent, like India, Sub –Saharan Africa or South America. Remember co-existing conditions such as Marfan syndrome. Aorta and valvular disease can affect 9 out of every 10 patients with Marfan. Calcified aortic valves can be more common with renal disease and patients on dialysis.
Patients with known aortic disease can feel anxious and present to the GP with worries about work, lifestyle and exercise. Public knowledge about aortic stenosis is low and as GPs we have a chance to educate our patients, screen our patients, refer our patients and support them. Be suspicious, investigate and refer heart murmurs on. As GPs, we need to take time to listen to our patients and listen to their hearts.