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Treatment for pulmonary hypertension - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2009
Answered : 594 Questions
User :   My father is a 65YO diabetic in A fib for 3 months. Cardioconversions have failed. His ankles are swelling and is extremely breathless. 2 days ago he was told he has moderate to severe mitral regurgitation. EF is 30 - 35. We have obtained his records and see that an echo 5 months ago showed mitral regurgitation, pulmonary hypertension, enlargement of right side of heart, among other things. Obviously he has been mismanaged and we need new doctors. My question is: what specialty/subspecialty should we get the 2nd opinion from, should we do it before the cathet. or wait for the results, and how fast should we be pushing to have done?
Doctor :   Hi
User :   hi
User :   ok
Doctor :   Heart faiure, Afib needs cardiology consultation
Doctor :   Does he has long standing high BP
User :   not cardiac surgeon?
User :   yes
User :   well managed
User :   last TEE results: User :   TEE results left ventricle moderately dilated mild concentric left ventricular hypertrophy overall left ventricular systolic function is moderate-severely impaired with EF between 30-35% left atrium is moderately dilated mild aortic valve sclerosis without stenosis trace amount or aortic regurgitation moderate to severe mitral regurgitation is present predominately on anteriorly directed jet non complex (less than 4mm) atherosclerotic plaque located in the transverse aorta there is no thrombus located in the left atrial appendage
Doctor :   At this point we need to know whether theres is any stenosis of heart vessels
User :   Is that what XXXXXXXX procedure is for?
Doctor :   Interventional cardiologist will do the heart XXXXXXXX and if there is stenosis he will put stents
Doctor :   Ech results+ symptoms are consistent with severe heart failure
Doctor :   Yes heart XXXXXXXX is done for that purpose
User :   is he at high risk of sudden death then?
Doctor :   There are complications with the procedure
Doctor :   But relatively it is safe
Doctor :   It not a surgery
Doctor :   It is an procedure
User :   So should we be pushing for 2nd opinion and XXXXXXXX procedure to be done very soon? It is scheduled 2 weeks from now with the cardio that missed the diagnosis.
Doctor :   They put dye thru femoral artery and see the vessesl
Doctor :   and from the same artery they will approach the heart vessels and put stents
Doctor :   No need
User :   Is valve replacement indicated in 65YO diabetic in heart failure?
User :   usually
Doctor :   He may has ishemic heart diesease, it is good idea to have the look at heart vessels
Doctor :   Still he can has ischemic heart
Doctor :   The XXXXXXXX part is not urgent
User :   ok thanks
Doctor :   Most imp thing for Afib - blood thinners and controlling the heart rate
Doctor :   Once it cools of then the heart issue come
User :   yes. inr is over 2
Doctor :   Once it cools of then the heart XXXXXXXX issue come
Doctor :   Sorry tell me what is that
Doctor :   Misty: yes. inr is over 2 : can you explain?
User :   blood clotting factor
User :   2 = 2 times normal
Doctor :   that is called INR and it should be between 2-3
User :   yes
Doctor :   Because he has new valve Cardiologist target me may 3.5
User :   he has not had valve replacement yet
Doctor :   So once the Heart rate is controlled and on blood thinner for 4 wks you can try again for Cardio version
Doctor :   OK
User :   would fixing or replacing the valve possiblt reverse the CHF even somewhat?
Doctor :   NO
User :   so is it possible to improve his quality of life? breathlessness and fatigue are severe
Doctor :   Quality of life depends, on medical good medical management
Doctor :   Some times in extreme cases, they might need oxygen at home to breath better
Doctor :   Are you there?
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