Over the lifespan of the NHS, one of the most important developments in cardiology and cardiothoracic surgery has been the development of diagnostic technology which allows us to get an accurate diagnosis when someone presents with symptoms.
Before echocardiography
When the NHS was established 70 years ago there was no imaging technology which could give you a picture of what was going on inside the heart. Doctors had to rely on clinical findings when they examined the patient.
One of the great things about the heart is that it does provide lots of clues which a good clinician can pick up by careful examination, especially with the use of the stethoscope, but the art of cardiovascular diagnosis was transformed in the 1970s by the advent of echocardiography.
Developing the technology
Echocardiography is the name given to ultrasound examination of the heart. As we all know, we cannot do better than to mimic the mechanism found around us in the natural world, and several animals such as bats and whales have evolved fantastic abilities to navigate in the dark and to locate objects underwater by using very high frequency sound waves – so-called “echolocation” or sonar.
This technology was adapted for use by submarines in the British Navy during the first world war, but later in the 20th century, Inge Edler, now often called the “father of echocardiography”, realised that the very same technology could be harnessed to locate moving structures in the heart, such as valves and even the flowing blood itself. In 1969 he demonstrated, using the principles of sonar and Doppler, that we could show the movement of the mitral valve leaflets in a patient with a damaged, tight mitral valve.
Echo came into the NHS in the early 1970s and many people were very cynical about it, refusing initially to believe the results or that it could safely be used to influence clinical decision-making. Fortunately, here at Harefield, we had Professor Sir Magdi Yacoub, who has always been a champion of pushing forward the boundaries and doing all we can to improve care. Working with the paediatric cardiologists, he encouraged the use of echo and soon it became routine.
Of course, the 'images' we were seeing then would not be recognised by today’s junior doctors as pictures of the heart – they consisted of a series of dots and lines in black and white. However, over the last four decades, incredible advances in computer power and software technology have resulted in machines which can convert those dots into the beautiful moving three-dimensional pictures of the heart that we recognise today.
Echocardiography in the 21st century
Echocardiography does not use ionising radiation, so it is extremely safe for patients to have the test as many times as they need to. Here at Harefield we do our scans with the patient facing the sonographer, which means that they can see the screen and also enjoy a conversation with the healthcare professional, which builds rapport, increases confidence and also often helps us to get more clinical information.
Echocardiography is the powerhouse of the cardiology and surgical imaging unit, as almost every patient will have at least one scan during their patient journey – and many will have several scans to follow their condition and monitor for any progression, allowing us to alter medication or time intervention appropriately. It is also great fun to do, if you are a doctor who likes playing the detective and working out what is going on, which is my favourite aspect of cardiology.
People sometimes ask “what did we do before we had all this technology?” Well, the answer is simple – we got it wrong more often! When echocardiography came into routine use for the diagnosis of heart murmurs, lots of patients who had been told what was wrong with them many years earlier discovered that they had something entirely different! Fortunately, the echo we have today means that our patients can be confident that we will we get it right first time.
Dr Shelley Rahman Haley is a consultant cardiologist and the first clinical lead for echocardiography at Harefield Hospital.