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Suffering from rheumatic cardiac disease, having joint pain. Diagnosed as thickening of mitral valve. what to do?

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Practicing since : 1981
Answered : 922 Questions
My mother age-65, suffering rheumatic cardiac disease... she has joint pain too... BP - 90/150.. regarlarly taking "Amlobet" drug since long.. weight about 60 kgs, doctors suspects mitral valve malfunction. She tires with work. Recent I Dopler was done.. that says thickening of mitral valve, what to do??? please advise medications
Posted Mon, 30 Jul 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 1 hour later
Thanks for writing in.
I am a qualified cardiologist and read your question with diligence.
Let you be clear on one issue, that is surgical treatment if considered:
1. It will involve doing coronary angiography as she is >50 year old.
2. It will involve opening of ventricle with an intention of doing repair but most such patient land up in getting Mitral Valve replacement. Ideally, she would need a mechanical valve with life long treatment with anticoagulants.
Before, I suggest, additional medications for your doctor to prescribe.
I want to be sure about two things:

1. How much is her effort tolerance, walking on level makes her out of breath after covering how much distance. And does she ever gets chest pain.

2. I saw the report of echocardiography and Doppler, I found mild mitral regurgitation with normal Left Ventricular Function that is per se not an indication for replacing valve. I specifically want to know her mitral valve area either by 2 D echo or pressure half time on Doppler.

Does she suffer from any other illness like Diabetes, how much is her weight and height, how much is cholesterol are other information needed by me before I give a final suggestion about medication.

Looking forward to hear from you.

With Best Wishes

Dr Anil Grover, Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: Suffering from rheumatic cardiac disease, having joint pain. Diagnosed as thickening of mitral valve. what to do? 36 hours later
Respected Doc,
In reply to your queries I'm submitting the followings
(a) Patient name - Gouri XXXXXXX Age - 65 years, Height - 63 Kgs, Height - 5 ft 4 inches
(b) Effort tolerance - She can walk 1 km or above when in normal condition. She never had a history of chest pain in recent 5 years. She does not suffering with diabetes.
(c) Blood Biochemistry -
Glucose -88(F) / 145 (pp)
Lipid Profile -
Cholesterol - 195 mg/dl
Triglycaryde -148 mg/dl
HDL - 67 MG /DL
LDL - 98 MG/DL

(d) Regarding Mitral valvae area : I am in such a place from where the nearest lab is 340 kms away with very few vehicle. Please go through the reports you have and advise medication.

BRIEF HISTORY : The disease are in course in her early 40 years of age. The medication was Penidure - LA12 at 21 days interval and continued upto six months. Later in 2001, doppler was done and medication was given (i) Tab. Amlobet (ii) Amiodar 100 (iii) Cap EC-350. In 2007 Again doppler was done and the previous medication runs as usual. She discontinued taking Amiodar-100, but the Amlobet was taken regularly to control BP

So far I'm aware of i had written, I'm always looking forward to control the disease by medication only and at the age 65, surgical possibilities can't be tolerated by the patient. So please advise, the documents regarding blood biochemistry and Echocardiography was already sent to you.
Answered by Dr. Anil Grover 1 hour later
Hi there,

Thanks for writing back. I am fully aware of your geographical location. How much expensive is to go to Guwahati from where you are? If treatment in Medical College Hospital were to be only minimal charges basis. I might give you a reference or two there.

What I am doing is making critical assumption based on available data that her Mtral valve is NOT NARROW ENOUGH TO WARRANT a Closed Balloon Mitral Valvotomy (a much minor surgical procedure regularly done in patient aged 70's) which would be possible only in Assam. I am assuming she has mild to moderate MS with mild MR in which later diagnosis is well documented. She also has mild Aortic valve disease as per echo.
Following suggestions for her treatment:
1. Request your doctor to change her medications for BP from vasodilators, I see Amlidopine there. It can be changed to B Blocker alone.

2. Add a K+ retaining diuretic, your doctor would know this to hold pulmonary venous congestion. Ditide or lasilactone is good drug in this situation.

She is sinus rhythm and will not need any other drug if BP can be controlled with the above two. Her EKG needs to be reviewed and she should also be ruled out for coronary artery disease. You can send me her EKG scanned if no one can interpret there. He lipid profile is normal. I hope her fasting blood sugar is also normal.

Best Wishes.

Dr Anil Grover, Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Above answer was peer-reviewed by
Follow-up: Suffering from rheumatic cardiac disease, having joint pain. Diagnosed as thickening of mitral valve. what to do? 13 days later
Dear Doctor,
Uploaded the EKG scan to interpret. I have started medication B Blocker (Atten-50) and Lasilactone -50 as per your advice and with consultation my family physician. I have seen some side effects of diuretic. Kindly reply The following questions -

a) How long the lasilactone-50 to be continued?? As the patient is unwiling to go with the surgery you suggested.
b) I read the possible side effect page.. , is it necessary her lifestyle to be changed?
c) Pl. suggest the tests which I need to be monitored regularly.. and to consult regarding the alteration of dosage.
d) In Tripura there is no DM Cardiology available.. I am trying to get her to cardiologist soon, by one or two month. As you have seen the uploaded reports, based on this suggest a long term solution against the disease

thanking you
Answered by Dr. Anil Grover 1 hour later

I could find only ECHO report by Dr P K Hazra which you have labelled ECG.jpg file.
I get your point about medical treatment and non surgical treatment. In fact after reviewing all the reports which you have sent me; though you have not answered the question in my first reply about her effort tolerance I DO NOT THINK SHE NEEDS SURGICAL REPLACEMENT OF VALVE (AS LV SIZE IS NORMAL AND MR IS MILD TO MODERATE) To answer your questions
a). You can continue Lasilactone till there is significant improvement in symptoms.

b). I could not understand changes in life style question.

c). Please get one echo done by DM or DNB cardiology specially for mitral valve area. That is to be repeated every year thereafter. When she is on lasilactone, her serum potassium should be monitored say every 15 days. Get one x-ray chest PA view done and keep it for comparison for future.

d). You may send me reports of cardiologist when you can manage to get echo done by a trained person,
You please make a list of question and call me telephonically tomorrow Sunday at 0000 at 11 AM send an SMS at 10.30 AM. I do not know you will have to ask healthcare,com people to organize the call. Send he recent scanned EKG and written reports of echo as well as list of medicines written in capitals by chemists as the prescription is illegible by EMAIL to YYYY@YYYY . You may include your list of questions also. This way I can give you a written elaborate reply, should the telephonic call does not materialize.
Best Wishes.

Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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