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Aorta stenosis,malfunctioning mitral valve,sleep apnea,congestive heart failure,rheumatic fever

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Practicing since : 2002
Answered : 2565 Questions
My dad has been diagnosed with severe aorta stenosis. He has refused treatment due to a malfunctioning mitral valve that was replaced 30 years ago. At this time we have turned to hospice to monitor his health. His breathing is heavy most of the time forcing to sit at the end of his recliner to help him breathe but when he sleeps he has apnea. This is so painful to watch. This severe congestive heart failure has been apparent for about a week. His cardiologist didn't give him long to live but he seems to be eating well and his vitals are still good. How long can he expect to keep living with this heavy breathing? He is 85 years old, weighs 144 pounds and is 5 feet 2 inches. He had rhuematic fever as a kid. He is on cuemiden (sp?) and laisix.
Posted Thu, 19 Apr 2012 in Valvular Heart Disease
Answered by Dr. Robert Galamaga 1 hour later
Hello and thanks for the query.

Your question is a very good one and I will try to give you some information and recommendations regarding what is going on with your father. As you have indicated he does have a very severe case of aortic stenosis in the setting of congestive heart failure. He is an elderly gentleman obviously and with these conditions. It is very difficult for him to maintain a good quality of life.

You have done the right thing by involving hospice in the care of your father. This organization generally specializes in helping to mitigate symptoms that are associated with end stage of diseases. Some of these symptoms include anxiety pain as well as shortness of breath. As far as your father is concerned. The shortness of breath certainly should be something that the hospice can handle.

There are excellent medications available which can help diminish the discomfort and anxiety that goes along with being short of breath. These medications include morphine as well as Ativan. Generally when patients have this much difficulty we schedule morphine and Ativan around the clock in order to help make people more comfortable.

It is really very difficult to predict how much longer you can expect your father to live. At this point I would estimate that his survival will be measured in weeks. At this point I would recommend that you discuss what you have observed with the hospice team. Generally a hospice physician can set up a regimen of medication as I have previously discussed which may really provide benefit to your dad.

Again I thank you for submitting your query. I hope you have found my answer to be both helpful and informative. If you have any additional concerns regarding this issue I would be happy to address them.


Dr. Robert.
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