Screening for unrecognised heart valve disease
The screening appointment: having the heart scan
Recent improvements in scanning equipment have made it possible to get high quality pictures of the heart using mobile equipment. This means heart valve screening can now be done in local GP surgeries, and the research study is looking at the advantages and disadvantages of this. Everyone who agrees to take part in the study is offered a first appointment at their GP practice (See also ‘Booking the appointment and getting there’).
The scan uses ultrasound technology, like that used in pregnancy to scan unborn babies.
Jo d'Arcy, Clinical Research Fellow, explains that the first screening appointment involves an...
Jo d'Arcy, Clinical Research Fellow, explains that the first screening appointment involves an...
Sex: Female
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So people who are asked to participate are those who are aged over sixty five who are registered with the General Practices that are participating in the study and who have not previously been told that they have valve disease.
Those people are being invited to attend their General Practitioners for their first study visit. What that then involves is a study visit that is about forty five minutes to an hour long during which time we ask them a few background questions about their past health, particularly things that might affect the health of their heart, such as their blood pressure and whether they have had problems with angina, that kind of thing, and we then undertake a scan of their heart, an ultrasound scan of their heart which is called an echocardiogram, and which takes about twenty – twenty five minutes. And allows us to have a good look at the structure and pump function of the heart, as well as looking at the valves in particular to look for any narrowings or leakage that might be there. What we do is we give people their preliminary results actually as they attend their first study visit so if their scan is normal we are able to reassure them at that stage and thank them very much for their participation and give them a copy of their results as well.
The heart scan builds up images of the heart’s four chambers and how well the valves are working. The researchers also check each person’s height, weight, pulse and blood pressure, take blood samples, ask some questions about their previous medical history and general health, and ask them to complete two short questionnaires. Overall the appointment takes up to an hour, of which 20-30 minutes is for the actual scan.
The scan is carried out by specialist staff from the research team who are trained to do heart scans, and who come out to local GP surgeries from the hospital. This means the appointments system runs separately from normal GP appointments. Generally people reported few problems with waiting times and found it all very efficient and relaxed.
Fraser did not have to wait long for the appointment. He describes the tests and scan, for which...
Fraser did not have to wait long for the appointment. He describes the tests and scan, for which...
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I think she was running about ten minutes late. And I had the 11.30 appointment and I was going to a gym class at 12.30, which was why I was slightly pressed for time. But I went down to the surgery, sat in the waiting room, was called in. It was a single room. There wasn’t anybody else there. It was a lady doctor, who said she was in charge of the medical side of that particular bit of the data gathering. I guess she was sort of mid 30s or something like that. And she took some initial tests. I think she took a blood pressure. She took a pulse rate [laughs], because I can remember I was struggling with the mental arithmetic of multiplying the pulse rate up by four to, to get [laughs] the beats per minute, and we had a laugh over that. And then, you know, take your shirt off, lie on the couch. And she had a screen, a sort of a laptop screen, and as she ran the probe over my chest, I could see sort of images that were coming up. And she was obviously going through some sort of schedule of various recordings in different places. And then turn round or turn over and, you know, do it from 90 degrees round. And, and that was it. I, I think the sort of slightly messy bit was probably about 15 minutes, you know, and “Here’s a bunch of paper towels, scrub the, the jelly off”, and, you know, off I went. She said, “I’ll write to you in five years’ time.” [Laughs]. And I mean, that was it then. Simple and straightforward.
Peg and Roy said the screening visit was very simple, just like going to see their doctor. Peg...
Peg and Roy said the screening visit was very simple, just like going to see their doctor. Peg...
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And so the actual appointment itself, Roy, why don’t you tell me what it was like from your perspective and what happened when you got there?
Roy' Well, the girl just said to me, they were doing this survey, so to speak, and she said, “Would you be interested?” So I said, “Well, yes.” I mean, it’s no problem and they could do it straight away anyway, so that was that.
And did you have to wait long?
Roy' No, no, she did it as I was there, really.
What actually happened? Can you talk me through what she did?
Roy' Oh, I can’t remember.
[Laughs] Can you remember what she did?
Peg' Yeah, well, she explained what the survey was about.
Roy' That’s right, yeah.
Peg' What she was going to do, and that she could see on her screen everything that was happening, sort of thing, and that she would show us afterwards. And she also explained that we would get a written result, and if there was any further appointments necessary at the hospital or anything, then they would get in touch. And it was just, well, it was just so simple. It was just like going in, you had a couple of wires attached to you and all the rest of it.
Roy' It was like going in to see the doctor, really, wasn’t it.
Peg' Yeah, well, it was.
Roy' Yes.
Peg' But
Roy' That’s as far as I could see, you know.
Peg' But it wasn’t quite so formal, was it?
Roy' No, no, no.
Peg' She was a very nice young girl, actually, that did it. She chatted all the time and what have you.
And you had to strip to the waist I think.
Peg' Yes.
Was that all right? Because I know they’re, they’re concerned that people should feel it was dignified for them. Was it okay?
Peg' Yeah. Yeah, that was no problem at all, you know. If you go to the doctor and they ask you to, you know, strip or something, you do it automatically. And I mean perhaps if it was a younger person then they wouldn’t be quite so willing to do that, but we both knew that it was a research.
Roy' That’s right.
Peg' And that we had to do what they wanted us to do.
Roy' I didn’t get her excited.
Peg' We didn’t have to [laughs]. We didn’t have to do it.
Roy' No, but I mean that was it.
Peg' We volunteered to do it.
Roy' Yeah, yeah.
Peg' Which we thought was the thing to do.
Roy' Yeah.
As Fraser, Peg and Roy explain, having the scan means you have to undress to the waist and lie on a couch. People generally understood the need for this and most people we talked to were not worried about it. However, Susie pointed out that for women of her generation it could be embarrassing.
Susie finds it embarrassing having to take her top off, but the person doing the scan was so...
Susie finds it embarrassing having to take her top off, but the person doing the scan was so...
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I went in and booked in, and the young lady come out, you know, that was doing the screening and she called me in. I think I waited about five or six minutes. She came in. She was a lovely lady, she really was, you know, and she asked me some questions. She took my blood pressure, which was normal. And she said to strip off to the waist, which I did, you know, and I had to lay on the couch, and lay on my left side, and I didn’t see the screen. And she came from the back and just put the monitor on, just on my chest, like. And you know, she was just so friendly you don’t even realise, you know. It made you feel so comfortable and, you know, I was really comfortable and yet I’m usually sort of a bit strung up. But I felt really comfortable.
Tell me more about that, you’re usually strung up. Do you mean you might have been a bit anxious about having to strip off and?
[Laughs] Well, I don’t know whether I ’m allowed to say this or not, but I don’t like standing in there with nothing on the top, and I said to her, I said, “The only thing I don’t like about this”, I said, “is showing everything I’ve got.” [Laughs]. And she smiled and she said, “No.” She said, “We don’t take any notice.” She said, “In fact, there was one lady that walked out when she knew that she had to strip down.” So I mean, at our age we’re not used to it, are we, you know? But I’d still rather do that than not go at all. So, you know, I overcame that problem [laughs].
Is there anything you think they could do to make it more dignified?
I don’t really know, because I mean to say they’ve got to have real access to show things up, haven’t they? So, really and truthfully speaking, I don’t think there is, you know. I mean, it’d be nice if there was. I know, when I used to go for the breast screening, you used to walk in there in the altogether, which was embarrassing, and now you can put a cardigan round your shoulders, which I think is nice, you know. They say it’s to keep you warm but it I think it’s to cover your dignity as well. So, you know, it is a good thing, but the heart screening I don’t think there would be, because they don’t want any obstacles in the way, really, do they? They want a clear view and things like that.
Do they just screen you from the front or is it from the back as well?
No, they just screen you, I had to lay on my side – it might have been, I forget about that, really. I had to lay on my side and she did it, she sort of come in from the back, and sort of reached over from the back and sort of done it there.
In Susie’s case, the relationship with the member of staff was vital in making her feel comfortable and reassured. The ultrasound staff all happened to be female. Several women, including Anne, Elizabeth and Pamela, said they would not have minded whether it was a man or a woman, but Carolyn and Rene said they preferred to have a woman if possible. Carolyn recalled some experiences with male doctors which made her feel quite strongly about this.
Carolyn has felt intimidated by male doctors since she was a teenager, and would always prefer to...
Carolyn has felt intimidated by male doctors since she was a teenager, and would always prefer to...
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I would prefer - I always prefer a female doctor, always. I think because as a teenager I felt intimidated by male doctors, I felt that they regarded teenage girls as idiots, [laughter] and wouldn’t take seriously any reason we went, so.
Was that a particular bad, single bad experience, or?
It was something like - I can’t remember exactly what happened. Oh yes, I can remember. I had a mole on the back of my neck that was sticking up, and occasionally it bled and made a mess on my school blouse, so I thought, “Go and see my GP”, who I’d known since early childhood. And he said, “Oh, we’ll soon cure that”, and he just literally took a pair of scissors and chopped it off. And it bled and bled and bled. I mean, I didn’t realise it was bleeding because it was behind my neck, but when I was on the bus going home the conductress said – worried, you know - she said, “Has somebody attacked you?” so I said, “No.” She said, “Well, you’re covered in blood down your back”. And I didn’t know it was bleeding like that. And that was his cavalier attitude, “Oh, we’ll just chop it off, stick a plaster over it”, and I thought that was, looking back on it now, I think that was absolutely evil to do that. And that rather destroyed my confidence [laughter] in middle aged male doctors [laughter]. But he just, you know, he just didn’t pay it any attention. These days I’m sure it wouldn’t happen, but for someone who’d known me since I was about five years old I thought that was disgusting.
Gosh, you know, it was quite a, quite an incident, really, wasn’t it?
Mm.
So that’s kind of coloured your whole....
Well, it did. I thought, “Once I’m independent I will always seek a lady doctor.” It wasn’t possible when I first came here, there was no female in the practice. But as soon as there was, although my male doctors were always excellent, I thought, “Right, I will keep to the female of the species [laughter].
Part B
Going off at a tangent completely, I had - in 1984 - I had a lump in my breast which I hadn’t noticed, because in my ignorance I thought a lump would always protrude, not be within, contained within the breast. So when I found it I went to the doctor, saw the surgeon, consultant, whatever, and it was extremely hard, and it had, he said it had grown very rapidly. He did two biopsies, both of which were negative, and he said, “I still think it’s cancerous. I would like to take your breast off.” And I said, “Well, until you can prove to me that it is cancerous just take the lump out.” “Well, that means I will have to do two operations.” I said, “Well, quite possibly you will, but I’m not willing [laughter] for you to lop it off.” And he said, “But its redundant material. You’re not going to be breast-feeding anymore.” [Laughter]. And I thought, “Lovely, this is what I’ve put up with from male doctors from the age of 15.”
There were many positive comments about the care and kindness shown by the ultrasound staff, their friendly manner, and the way they talked through what was involved and answered questions. Being able to see the pictures on the screen afterwards was something several people liked.
Brian couldn't fault the way the technician explained it all. She showed him the pictures on the...
Brian couldn't fault the way the technician explained it all. She showed him the pictures on the...
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Oh, she was very nice, very nice, and tried to explain everything in detail. I couldn’t fault the way that she put everything over. I mean, and as I say, at the end of it when she found this small leak, she showed it me on the screen. I mean, I looked at it, but obviously it was so minute I didn’t even know, she pointed out where it was and that, but I mean it wouldn’t have meant anything at all to me, but obviously it did to them [laughs].
Yep, yep, and did you have to wait long when you got there?
No, no, very good.
Yeah.
I went for a certain time and within five minutes they come down and collected me.
Okay.
There was no trouble. It all went everything smooth.
Anthony was fascinated by the ultrasound technology. He and Pamela found the whole experience...
Anthony was fascinated by the ultrasound technology. He and Pamela found the whole experience...
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Pamela' We went to the Health Centre and we sat in the waiting room and she called us in, and I said to her, when I went in, that the next day I was going to see a surgeon about the breast cancer, you see. So I said, “Do you want me to come, because of that?” and she said, “Oh no, that doesn’t make any difference.” And it was all very nice in there and she was a really nice girl, and I quite, you know, I didn’t mind being there at all, it was fine. Very easy and nice, wasn’t it?
Anthony' Yes. Actually I went - we went in one after each other. I went in first, and I was very interested in the equipment apart from anything else , you know, it was something which I found quite interesting. She actually showed me pictures of my heart and what not, which I found very interesting. It was very good.
Did she show you while she was doing it or was that afterwards?
Anthony' Afterwards. Well, after she’d actually done it we started talking to each other about things and I said, “Well, we used to use ultrasound for crack detection in metals” and she said, “Would you like to see it?” and I said, “Oh yes I would, really very, very much!” and it was very interesting, yes. It—
And - sorry.
Anthony' It was surprising how clear the pictures were as well. It was very good.
And was it comfortable and dignified?
Pamela' Oh yes, all lovely, yes.
Anthony' Yes, it was very, yes.
Pamela' Yes, all very nice.
Anthony' There was no stress or anything of the sort. In fact, just the opposite! It was quite an enjoyable sort of experience, in a way [laughter].
I think you have to strip to the waist don’t you, was that a problem?
Pamela' No. No, since then I’ve had to do that so many times [laughter]. No, no, we’re not silly like that.
Anthony' No, no.
Would you have minded more if it was a man doing it?
Pamela' No, it wouldn’t make any difference, no.
The ultrasonographer was excellent, in Elizabeth's view. The gel on her chest was a little cold...
The ultrasonographer was excellent, in Elizabeth's view. The gel on her chest was a little cold...
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And what was the actual screening like? Can you talk me through what she did?
Yes, she put lots of jelly on me and then set up the, what do you call it?
The screening?
The screening, yes, and went over me with it, a little bit cold. But it was perfectly all right. Yes, there were no problems.
Could you see the screen while she was …?
Yes, I could.
Ah-hah.
I could, which was very interesting, but not very knowledgeable to me [laughs] but it was very interesting and she was showing me different parts of it and talking me through it, which I found very interesting. And yes, it was, she was excellent.
And I think you have to strip to the waist…
Yes, you do.
Is that all right with you, or?
Oh, perfectly all right with me. No, perfectly all right with me.
Because obviously they can’t do their screening if you don’t, so why worry?
I know it’s one of the things that they, they want to be sure that people feel they’ve been treated with dignity and--
Oh yes, she was--
privacy…
--excellent, excellent. And then we went through it afterwards and everything was fine, which I was pleased about.
Lech said how impressed he was that the technician could tell from the scan pictures that he had had a heart attack in the past. Occasionally people who were told something was wrong said they would have liked to have more information or to be able to put questions to a doctor, and this is discussed further in ‘Getting results’ and ‘Attending follow up appointments’.
Ultrasound scans are painless, so few people reported any discomfort from having the scan, apart from a few minor comments about the gel on your chest feeling rather cold. The only exception to this was when people found it uncomfortable to lie on their side, but staff found alternative ways to do the scan.
Last reviewed August 2016
Last updated August 2016.
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