Useful resources

Currently all of our clinics occur exclusively at the Leeds General Infirmary and we are located on E Floor of the Jubilee Wing.  This site is in the heart of Leeds city centre so please allow ample travel time to get here. Parking at this site is also limited; please bear this in mind when planning your visit. Please click on the ‘Contact Us’ link on the left-hand side for a map of the site and directions on how to get here.

We look after a wide range of patients with a variety of heart valve conditions and we run a number of different clinics which are specific to each patient’s needs. 

Those with more complex heart valve disease or those who have developed new cardiac symptoms will be seen by one of our Consultant Cardiologists.  These consultations tend to take a little longer so be prepared to be at the hospital for 1-4 hours. Around half of the patients in this clinic will have an echocardiogram on the day. 

Patients who do not need to have any additional tests, and who are known to the team, may be offered telephone follow up with the consultant as an alternative. These consultations tend to take around 30 minutes.

Those with long-term stable valve disease, or those who have previously had surgical or key-hole intervention on their valves may require long-term follow up. For this, we have a specialist valve nurse clinic. These consultations are usually on the telephone however face to face appointments are also available. These consultations tend to take around 30 minutes.

Patients who feel well and require long-term monitoring with echocardiography will be seen in the specialist valve sonographer clinic.  This clinic involves a brief clinical assessment with a dedicated cardiac ultrasound on the day – you will receive the results of the scan on the day and on-going follow up will be arranged during the consultation.  These consultations usually take 30-60 minutes depending on the complexity of your heart valve disease. 

If you have received an appointment to be seen in the Congenital and Children Cardiology Service please view their page. If you have received and appointment to be seen in the TAVI service please view their page.

Valvular heart conditions are chronic and often progressive and this means we may need to do a number of tests either on the day or before or even after your consultation. We endeavour to have as many of these completed in a single visit however this unfortunately is not always possible.  We often ask for an ECG, echocardiogram and a blood test during your appointment. We may request an MRI, CT, transoesophageal echocardiogram, ambulatory monitor, exercise test or coronary angiogram to be completed at a later date. For more detailed information these specific tests, please see the ‘Tests you may need’ leaflet.

Please bring a list of your current medications with you. If you wish to bring a family member or friend with you to your consultation you are welcome to – we encourage you to bring someone if you have memory or mobility issues. You do not need to wear any specific clothing and you can eat and drink as normal prior to your appointment.  

Following your appointment with your heart valve specialist you will be sent a letter about the consultation. This is designed for yourself but also for your GP and hence it will contain some medical terminology you may not understand. If you have any queries please get in touch.  If you require any further tests after your consultation, you will receive an appointment for these in the post and then we will either write or ring with the results.

Please contact us to rearrange the appointment well in advance – we look after a large number of patients and hence with enough notice we may be able to offer a different patient the appointment if you can’t make it.  Please contact us on 0113 3926642 to rearrange your appointment in the Doctor or Nurse Led clinic and please contact us on 0113 3922063 to rearrange your appointment in the Sonographer led clinic. 

Transthoracic echocardiogram (‘echo’ or cardiac ultrasound)

this is an ultrasound scan of your heart and is the key test for diagnosis and monitoring the progression of valve disease.  It is similar to when a pregnant lady has a baby scan.  You will need to undress to your waist and you will be offered a gown. You will be asked to lie on a couch on your left-hand side and 3 ECG stickers will be placed on your chest.   A probe with ultrasound gel will be placed on your chest, your stomach and your neck. The gel may feel a little cold, but it is not painful and completely safe. The test should take no more than 30 minutes. We obtain moving images of your heart to assess the structure and function of your heart chambers and valves.

ECG

this is a tracing of the electrical activity of your heart, takes only a few minutes and is completely painless. You will be asked to undress to your waist. Sticky dots will be positioned on your chest, arms and legs to record your heart beat. This test is performed by male and female physiologists.

Blood tests

a small number of patients will need to have a blood sample taken.  This may be done in the clinic, however depending on demand you may need to visit the blood taking department or your GP for this to be completed. A common blood test we perform is to assess the levels of an enzyme called B-type natriuretic peptide (BNP).  As your heart has to work harder to compensate for your valve disease, the levels of BNP in your blood will increase over time and so this helps with planning appropriate follow up and timing for intervention.

Transoesophageal echocardiogram (TOE)

this is a specialist ultrasound of your heart with images obtained from inside your oesophagus (food pipe) and is similar to an endoscopy. It allows us to obtain more detailed images of your heart valves which helps us plan surgical or keyhole heart procedures. You can be given a small dose of sedation for this test to make you sleepy but this does not involve a full general anaesthetic. You cannot eat for 6 hours prior to your appointment and you will need someone to take you home.  If you are referred for a TOE you will be sent an information leaflet in the post with your appointment letter which provides more information about this test.

Magnetic Resonance Imaging (MRI)

this test allows better visualisation of your heart chambers, valves and the blood vessels leading to and away from your heart and is primarily used to better quantify the size of your heart and aorta.  You cannot have this test if you have certain kinds of metal in your body and it may not be suitable if you are very claustrophobic. You will be asked to lie on a procedure table inside a machine. This test tends to take around 45 minutes depending on the complexity of your valve disease and the machine can make loud clicks and beeps during the scan. You may need to be given an intravenous (through a tube in your arm) contrast agent or dye for this scan so please may us aware of any allergies or kidney problems if we recommend this scan to you.

Computed Tomography (CT)

this test allows better assessment of any calcification of your heart valves which is important when planning for intervention. It also allows better assessment of the blood vessels leading to and away from your heart which, again, is important when planning intervention.  You will lie on a procedural table inside a polo-shaped machine and usually takes around 15 minutes. You may need an intravenous contrast agent or dye for this scan so please make us aware of any allergies. You will need your kidney function blood test prior to this scan which we can arrange during your consultation.

Cardiopulmonary Exercise Testing (CPX)

 this test allows us to assess your functional capacity in the presence of valve disease. ECG electrodes, a blood pressure cuff and oxygen monitoring equipment is applied and you will be asked walk on a treadmill (or alternatively pedal on an exercise bike). The speed and incline on the treadmill will gradually increase and information relating to your heart rate, blood pressure and respiratory function will be recording. This allows us to better assess how your valve disease is affecting your ability to exercise and helps with planning appropriate follow up and timing for intervention.

Ambulatory monitoring

this test involves three ECG electrodes being placed on your chest and attached to a small monitor the same size as a cassette player. You will be asked to wear this for a few days and return the equipment to us. This will allow us to obtain a longer period of information about your heart rate and rhythm. This information allows us to better tailor medications for patients with certain types of valve disease.

Pulmonary function tests this is a breathing test which involves blowing in to a tube so we can measure your lung capacity. This information allows us to better plan for intervention and will be necessary for smokers / ex-smokers who are being considered for surgery.

Coronary angiogram

this is an invasive test which involves an injecting a dye or contrast agent into your coronary arteries via a small tube in your wrist and then obtaining x-ray of the blood vessels. This allows us to better assess if any symptoms you have are due to valve or to a narrowing in your coronary artery and also aids with planning intervention.  This is a day case procedure – you may need to be in our day unit for a whole day however the procedure itself should take around 30 minutes.

it is well established that smoking is bad for your health and there is evidence to suggest that smoking can increase the rate or progression of certain heart valve conditions.  It is very important that you give up smoking if you have heart disease of any form. Your GP and NHS stop smoking services can help you quit smoking.

maintaining a healthy diet is extremely important as being over-weight increases the risk of other conditions such as diabetes or heart disease and also makes any necessary surgery more high risk. Being over-weight will also have an impact on your recovery following any necessary interventions on your valve.

unless specifically instructed not to by your valve specialist, exercise is very good for you – not only for your physical health but also your mental health. Being active also makes it easier to spot any symptoms which may be due to progression of your heart valve disease. Gentle exercise is actively encouraged for any valve patient. Those who wish to take part in more intense exercise should discuss this with their heart valve specialist, as certain sports / exercises should be avoided in certain valve conditions.

drinking alcohol in moderation is not considered harmful however drinking to excess can cause high blood pressure and even heart failure. This can lead to exacerbation of existing heart valve conditions, and increases the risk of any necessary intervention.  Alcohol can also interact with certain heart medications and therefore you should discuss this with your heart valve specialist. If you need help with your alcohol intake, your GP can assist with this.

taking intravenous (injectable) recreational drugs is extremely dangerous generally – and those with heart valve disease are at higher risk of developing infections on their valve if they inject drugs. This is a condition called endocarditis – please see the PDF for more information.

pregnancy and childbirth can both put excess strain on your heart and this can be important in heart valve disease depending on which type of valve disease you have and how severe it is. For many valve conditions, pregnancy is perfectly possible, but can be made safer for the mother and the baby if planned in advance and monitored appropriately.  If you have heart valve disease and you are planning on becoming pregnant or indeed do become pregnant, it is important you discuss this with your heart valve specialist as soon as possible. You will be referred into a specialist Cardiac-Pregnancy clinic for follow up during your pregnancy and to discuss birth plans (a Cardiologist, Obstetrician and Anaesthetist will jointly agree on a plan most suitable to you as an individual).

in a small number of cases, an abnormal aortic valve can be inherited and hence if we recommend clinical testing (echocardiogram) of all first-degree blood relatives (siblings, parents, offspring) to see if they have any features of the condition. If you have a bicuspid aortic valve and would like your immediate relatives to be screened, please ask for a ‘Dear Relative’ letter during your consultation.

Patients with heart valve disease are at a slightly higher risk of developing a condition called infective endocarditis. This is a rare but very serious condition where bacteria in the blood stream attaches on to the thickened or leaking valve.  It affects around 1 in 10,000 people per year and can be life-threatening if left untreated,

Any procedure which breaks the skin increases the risk of bacteria entering your blood stream and hence we recommend that you do not have tattoos or piercings. This includes tattoos, piercings, and use of injectable recreational drugs.  The most common way in which people with heart valve disease contract endocarditis is through poor dental hygiene and therefore it is important you take good care of your teeth, visit your dentist regularly and make them aware you have a heart valve condition.

Those who are considered higher risk for endocarditis include patients who had the infection before, those with previous heart valve repair or replacement, those with cyanotic congenital defects. If you fall within this ‘higher risk’ category will be advised to take prophylactic antibiotic therapy prior to certain dental treatment including procedures which perforate the oral mucosa, manipulation of the peri-apical region of the teeth or gingival tissue, sub-gingival scaling or extractions.

The symptoms of endocarditis are a little vague and are also often seen with other conditions, however should you suffer from those outlined below it is important you contact us immediately so we can rule out this particular infection.

• Fever (above 38 degrees)
• Night sweats (often described as ‘drenching’ where patients have to change their bed sheets daily
• Unexplained weight loss and loss of appetite
• Unexplained tiredness, fatigue and lethargy
• Generalised aches and pains

If you think you have endocarditis, please either see your GP or contact us on 0113 3925298 immediately. We will arrange blood tests, an echocardiogram and a review with the endocarditis team.