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Mitral valve prolapse with mild mitral regurgitation, arrhythmia. Taken clexane, metoprolol. Done echocardiogram. Second opinion for heavy dosage of drug?

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Cardiologist, Interventional
Practicing since : 1996
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Your opinion of this combination of drugs :

I am a Caucasian male, 70 years old. In 2003, a cardiological report stated the following:

1)      Isolated ventricular premature beats and atrial ectopic activity, occurring in the absence of significant underlying structural heart disease.
2)     Mitral valve prolapse with mild mitral regurgitation.
3)     Patent foramen ovale with bidirectional shunting.

At time of report in 2003, no particular therapy was undertaken and no activities were restricted. There was no evidence of sustained atrial arrhythmias and no repetitive ventricular ectopic activity. No antiarrhythmic drug therapy was prescribed at that time.

Recently I began to notice many irregular heartbeats and began taking my pulse regularly using a digital pressure and pulse instrument. I do not have sustained high blood pressure, only an irregular pulse. The last 45 readings have shown a consistently irregular pattern.

Because of the irregular pulse, I went to see a cardiologist today in a small town here in XXXXXXX where I live. While in the clinic, my blood pressure was much higher than my own recordings at home.

The cardiologist ordered an EKG and an echocardiogram. Based on my 2003 report, my recent pulse measurements and the results of the EKG and echocardiogram, he prescribed the following medications:

Clexane 6000 IU/0.6ml – 2 x 1
Cordarone 200 – 2x2 = 800 mg daily
Metoprolol Succinate ER - Seloken ZOK, 1x1, 50mg tabs
Coumadin – 5 mg, 1x1
Coraspin 100 – aspirin

Many of these drugs have serious interactions and seem to be a heavy dose. Do you think I should take them or get a second opinion from a different cardiologist?
Posted Fri, 27 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 16 hours later

Thank you for your query.

If your pulse is irregularly irregular, it is highly probable that you might have developed atrial fibrillation (AF). This is an arrhythmia wherein the atria (the receiving chambers of the heart) have chaotic electrical activity and do not contract properly and can result sometimes in rapid heart rates. Also, blood clots can form within the chambers due to sluggish blood flow. The drugs that have been started are indicated to control the arrhythmia and prevent the thrombo-embolic complications that are commonly seen with AF.

However, before I discuss the need and dosages for these medicines, I would like to know the ECG and the Echo findings.

I can give you a specific answer after reviewing your ECG and echo report.

Awaiting your reply with the reports.

With regards,
Above answer was peer-reviewed by
Follow-up: Mitral valve prolapse with mild mitral regurgitation, arrhythmia. Taken clexane, metoprolol. Done echocardiogram. Second opinion for heavy dosage of drug? 22 hours later

EKG: TA: 154/97
HR: 113/min (pulse)
RR 533 ms
QRS: 92 ms
QT: 318 ms
QTC: 436 ms

Axis: P - ° S (V1) -0.50mV
QRS 56° R (V5) 1.95 mV

Diastolic dıameter: 45
Systolic dıameter: 27
Aorta : 36
Left Atrium: 41
IVS: 12
PW: 12
EF: 60%
Right ventricle: 27
Pulmonary velocity: 0.9 ml?

Mitral Closing
E & A velocity: arrhythmic (no values given)

T 16° Sokol. 2.90 mV
Answered by Dr. Raja Sekhar Varma 45 hours later

Thank you for the reply.

The measurements of the intervals from the ECG that you have given are within normal limits. But, without actually looking at the ECG, it is not possible to identify the arrhythmia.

The findings of the Echo suggest that there is a mild thickening of the walls of the heart. This may be a response to hypertension or sometimes, even age related changes. Ejection fraction is normal, which suggests that the pumping of the heart is normal.

Kindly clarify the following:
1) If there are any descriptive findings (conclusion) on the echo report, please mention that.
2) If a specific arrhythmia diagnosis has been made, please mention that too.

Inj. Clexane is a low molecular weight heparin, which is given to prevent the blood from clotting inside the blood vessels/heart.

Coumadin is an oral anti-coagulant which is also given for the same purpose. Since the effect of coumadin takes a few days to stabilize and since there may be a pro-caogulant activity initially, Clexane is given during the initiation of the oral anti-coagulant therapy.

Aspirin is an anti-platelet drug which is given for the prevention of strokes/heart attacks.

Cordarone (Amiodarone) is an anti-arrhythmic drug which will treat the arrhythmia to achieve normal sinus rhythm, as well as help to maintain sinus rhythm. While 800-1200 mg/day is the starting dosage, once stable blood levels of the drug are reached, the dose can be reduced gradually to achieve a final maintenance dose of 50-200 mg/day.

Metoprolol is a beta blocker which has multiple effects on the cardiovascular system. It is useful in controlling the blood pressure, has beneficial effects on prevention of heart attacks, improvement of cardiac function and slowing of the heart rate.

I hope this answers your query. Feel free to contact me again for any further clarifications.

With regards,
DR RS Varma
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