Hello! Thank you for asking on HCM! I understand your concern and would explain that heart valve dysfunction may be recognized sometimes only after some complications occur. Sometimes heart failure is the reason why patients seek medical help, sometimes shortness of breathing, fatigue, or even gastrointestinal symptoms (from hepatic and splanchnic congestion) are the leading symptoms and signs to the right diagnosis. Also, endocarditis manifested with fever, heart failure, and other systemic symptomatology may be the first presentation of a cardiac valve disorder. A comprehensive physical examination, coupled with a cardiac ultrasound and additional lab tests are necessary to drive on the final diagnosis. Hope to have been helpful to you. Greetings! Dr. Iliri