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Dr. Andrew Rynne

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Have HBP. Knee joint replacement to be done. Advice some precaution and cure to be taken

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Dr. Stephen Christensen

General & Family Physician

Practicing since :1986

Answered : 212 Questions

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Posted on Sat, 12 Jan 2013 in Hypertension and Heart Disease
Question: Ecocardiography for my mother 67 have below mentioned indications:

Mitral valve - Grade-1 MVP (aml)
Doppler study - mild MR
LV - compliance - reduced
There is inflammation on one of the valve (could be Endocarditis)

Apart from this she have unusually high blood pressure 160-170/95-100 even after taking 6 different tables a day. She recently suffered TB (non-infectious) and completed antibiotics course of 9 months. Aslo, she have only one kidney by birth.

Ecocardiography was done because she is to be operated for both of her knee joint replacement and we came to know about the indications just today morning.

What should I watch for and how to take care of her? What are the precautions I should keep in mind and should I go for knee joint replacement right now or should wait till some more time and watch for what? Kindly adivce on this as I am almost 1200 miles away and going to stay with to take care of her and need some directions before I talk to doctors and decide further..
doctor
Answered by Dr. Stephen Christensen 6 hours later
Hello. I'm Dr. Christensen.
I'm sorry your mother is having problems. Regarding her upcoming surgery, the most important considerations are getting her blood pressure under better control and making certain she does not have endocarditis, which is an infection (usually bacterial) on the interior surface of a person's heart (typically on a valve). Symptoms of endocarditis can be subtle -- fatigue, for example -- or they can be more obvious: chest pain, fever, night sweats or shortness of breath. In addition, bacteria from an infected valve can travel to other areas of the body, causing serious or even life-threatening complications: sepsis ("blood poisoning") or abscesses in the brain, spleen, kidneys or other organs.
Individuals with endocarditis shouldn't undergo joint replacement until the endocarditis is treated, because bacteria from the infected area of the heart could enter the bloodstream and infect a new joint prosthesis. Further evaluation (blood tests and possibly a trans-esophageal echocardiogram) may be needed to determine if your mother has endocarditis. If so, IV antibiotics might be needed to treat this condition.
Your mother's high blood pressure could be the result of her congenital kidney anomaly. Our kidneys play a major role in controlling our blood pressure, and any problems with kidney function can lead to high blood pressure. Further consultation with a cardiologist and/or a nephrologist (a kidney specialist) may be warranted in your mother's case. While people with high blood pressure often undergo surgery, it's best to have this problem under control if at all possible. (By the way, people with high blood pressure frequently exhibit reduced left ventricular compliance on an echocardiogram.)
As far as the mitral valve prolapse (MVP) is concerned, this is a common condition, and your mother's MVP is mild. Mild MVP does not prevent someone from undergoing surgery, and in most cases doesn't even require treatment. In fact, people with mild MVP typically don't even have any symptoms, so you don't necessarily need to watch for problems arising from this condition.
In summary, you should ask your mother's doctors what needs to be done to make sure she doesn't have endocarditis, and someone -- a cardiologist or nephrologist (or both) -- should review her medications to determine if anything else can be done for her high blood pressure.
I hope that answers your questions. I'll be available if you have additional concerns, but I suggest you call your mother's doctor(s) before you make a 1200-mile trip with the expectation that she'll be having her surgery soon. It sounds like there's some work to be done before she has her knees replaced.
Good luck!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Stephen Christensen 11 hours later
Thank you Dr. Christensen for taking interest and explaining/answering in detail. I have call scheduled tomorrow with my mother's doctors and certainly this is going to help a lot.

I have summarized my understanding and have some more questions, where I need your help.

* For confirming/ruling out endocarditis - Blood Culture test should be performed and if required a trans-esophageal echocardiogram should be required. Her ESR is high since almost 1.5 years now and doctors till now thought it is because of her Tuberculosis. Her TB treatment is completed and she is off the medicines now since 1 month and ESR (which was just taken yesterday) is still high. Could this be because of Endocarditis or it may be byproduct of her TB treatment?
* For better control of BP, I should talk to a Cardiologist and Kidney specialist.
* Last thing where I am little uncomfortable to ask you but I have read mix kind of reviews about knee joint replacement surgeries, is it safe and worth performing? Would I be putting her in more pain after operation?

Many thanks in advance for your time and patience.
doctor
Answered by Dr. Stephen Christensen 9 hours later
Your mother's elevated ESR could be due to endocarditis, but there are many other possible causes; anything that triggers inflammation can cause your ESR to rise. Given the findings of your mother's echocardiogram, though, endocarditis is the first thing that needs to be ruled out. Blood cultures and trans-esophageal echocardiography are the next steps in that evaluation.
The vast majority of patients who undergo knee replacement surgery are much improved once they get through the post-operative rehabilitation period, which can be quite painful. (Your mother will probably need help for at least 4 to 6 weeks.) As with any surgical procedure, complications do occasionally occur with knee replacements: problems with anesthesia, bleeding, blood clots, post-op infections, implant failure, etc. However, such problems only occur in about 1 in 50 operations. When a person can no longer perform his or her daily activities due to severe knee arthritis, replacing the joints typically restores a good level of function.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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