Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your mom's medical history and would explain that:

1) It is important to determine why her cardiac performance has dropped at these low values (around 35%).

If the previous cardiac tests (including Echo) has concluded a normal cardiac function and actually it results decreased, then probably a suspicion about the coronary artery disease presence may be rationale (especially if your mom has experienced lately chest pain symptomatology or other angina equivalents).

In such case, a thorough investigation of coronary artery disease is necessary including coronary angiography (coronarography), which will definitely clarify blood circulation inside her coronary arteries.

If the above scenario is present heart catheterization (coronarography) would be helpful. It is a routine cardiac test and when performed by experienced operators it is quite safe even at the age of your mom.

From the other hand, if her decreased cardiac function is just a similar picture from the previous Echo reports, then the most probable reason for this dysfunction may be adverse cardiac re-modelling due to chronic valvular disease (prior to surgery) and mechanical valves prostheses which not rarely alternate cardiac geometry, interdependence of several components of cardiac structure (ventricular chambers, papillary muscle, valvular annulus,etc.), leading to systolic cardiac dysfunction.

In such case a careful cardiac ultrasound (Echo) would be sufficient for evaluating cardiac performance, cardiac loading condition, cardiac prostheses functioning or malfunctioning, etc.

A medical therapy optimization (including diuretics and vessel dilators) is the right strategy for getting beneficial effects and improving the overall clinical status (especially breathing difficulty).

Also, pulmonary infection plays an important role in her actual clinical conditions, exacerbating further her breathing status and deteriorating heart failure symptomatology.


2) Regarding her possible age influence in cardiac tests selection, I could explain that there is no limitation in performing whichever her doctor has decided to do.

As I explained above, coronary angiography may be safely performed.

Also, MRI may be performed safely. Her mechanical heart valves will not suffer any adverse complications (displacement form magnetic fields or excessive heating). This is by clinical investigations will such patients undergoing MRI exams (with up to 4.7 Tesla magnetic fields).

So, nothing to worry about!

At the end, I would recommend following her doctor advice, as XXXXXXX Clinic has an outstanding excellence in cardiology field.

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again,

First, I would like to explain that heparin is not as terrible as you think. Its doses are easier manageable than warfarin in short term use.

Regarding kidney function, if there is not any known chronic renal disorder it is unlikely that diagnostic dyes will cause any adverse interaction.

Nevertheless, it is necessary to have the complete results of renal function before giving conclusive opinions.

BUN and creatinine, coupled with creatinine clearance test are sufficient to clarify this issue.

You should talk with her attending physician on the above tests.

Whether a coronary angiogram should be done or not, it will be decided after properly weighing the beneficial information drawn from this test with the potential complications (including adverse renal function implication).

Coronary angiogram would be necessary only if sufficient evidence of coronary artery disorders is present.

Nevertheless, my personal opinion is that decreased heart performance is more likely related primarily with the chronic cardiac valve disorders (as I mentioned you above).

If you provide me with the above mentioned tests (renal tests) results, I could give a more concrete professional opinion.

I remain at your disposal for further discussions whenever you will get those test results.

Regards,

Dr. Iliri

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