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Suggest treatment for coronary atherosclerosis

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General & Family Physician
Practicing since : 1992
Answered : 621 Questions
Patient is 72, recovering from massive stroke (approx 2 months prior,). He has an irregular heart beat, and blood pressure readings avg 90/65 and is at home going through rehab. His EKG, and Doctors have noted, that he has AF. (en spanish arritmia fibralacion auricular) . He has had a history of high blood pressure and had an event about 5 yrs prior to the stroke. Not sure what happen but his heart rate and Blood pressure readings were extremely high. Currently, very little monitoring or blood work is being done. The patient can go monthly to the hospital for blood work. Since November the patient has been taking Amidorana , telmisartan/hidroclorotiazida and rivaroxaban (dosages below). The carbamazepine was just added as a sleep aid, and Digoxin is a new medicine that the Doctors want to add to the "Cocktail". The patient is eating, has trouble sleeping, has aches and pains, and at times he is with us 100% (and even understand my terrible spanish) and other times he is in a confused state (5% to 15% of the guess). We are seeking additional assistance in determining if this cocktail is advisable, and what monitoring we should be doing if we continue with this cocktail. In Mexico there isnt a lot of care taken in prescribing medicine monitoring, so its up to the family to make sure what is being done is correct. Medical treatment in Mexico is not really integrated like in the USA, so when another Dr visits the house or we go to the hospital we take stacks of papers etc. Previous cocktail (Nov to present) Amidorana 200 mg telmisartan/hidroclorotiazida 40ngl Xarelto rivaroxaban 20mg 1 pill a day New cocktail (they want to start) Amidorana 100mg telmisartan/hidroclorotiazida 20 mg Xarelto rivaroxaban 20mg 1 pill a day carbamazepine (carbamazepina) 200 mg in the night Digoxin (Lanoxin Digoxina) 0.25 mg
Posted Wed, 19 Feb 2014 in General Health
Answered by Dr. Behar Greca 5 hours later
Brief Answer: Patient's problem is coronary atherosclerosis. Detailed Answer: Hi, thanks for posting. Patient's problem is related with coronary arteries, more exactly atherosclerosis. For a good performance of the heart, coronary arteries should be free(released). To treat this, the patient needs a anticoagulant treatment. In your case Xarelto rivaroxaban. But the dosage is dependent on INR(International Normalised Ratio) test result. If anticoagulant don't stabilize patient status, then the patient needs coronagraphy procedure. This test will show you the part of coronary arteries that is blocked and shows you the part that needs a coronary stent. First of all you need the INR test to get the right dosage for Xarelto rivaroxaban. The new cocktail(that they want to start) is okay. But you should remove Carbamazepine 200mg, because it has a lot of side effects and affects in heart beat. Replace this medicine with Amitriptyline 25mg 1 pill a day. The best choice for the patient is coronary stent because it will solve all his heart problems. Take Care.
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