West Virginia health officials are notifying more patients at a heart clinic in Beckley who may have been exposed to hepatitis after four additional cases of hepatitis C were detected by the state Bureau of Public Health.

The state Department of Health and Human Resources announced the additional cases on Monday, multiple media outlets reported.

In March, the bureau investigated 12 cases of hepatitis linked to injectable medications given during cardiac stress tests at the Raleigh Heart Clinic in Beckley.

Officials said eight patients receiving the tests tested positive for hepatitis C and four others tested positive for hepatitis B. There has been no evidence of HIV transmission.

The investigation started in November 2014, after a patient with no risk factors for hepatitis C was diagnosed with the virus.

On March 11, the bureau issued more than 2,300 notifications to patients at the clinic who underwent the testing between March 1, 2012, and March 27, 2015.

The bureau also set up a hotline that patients from the clinic could call to report any additional diagnoses.

According to Dr. Rahul Gupta, state health commissioner, the four additional cases were contracted before March 1, 2012.

“The four cases were discovered as a result of the success of the hotline, but cannot be conclusively linked to the clinic,” Gupta said.

Officials are now urging anyone who may have received a stress test at the clinic prior to March 1, 2012 to be tested for hepatitis B and C as well as HIV.

The clinic now only uses single use vials and single-dose medication, and they have switched to a needleless injection system.

The Charleston Gazette-Mail reports (http://bit.ly/1T3P4dH) that at least two lawsuits have been filed against the clinic since late March in Raleigh Circuit Court.