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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for atrial fibrillation attack With SVT

Answered by
Dr.
Dr. Rajaram KG

Orthopaedic Surgeon

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Posted on Wed, 26 Nov 2014 in Heart Attack
Question: My wife has heart Disease >>on Aug 19 She had Atrial Fibrillation attack With SVT (ventricllar) >The heart at the time they did an Ecko & the heart was running at only 10%>> Every thing was shutting down.They got everything straightened out.. They did an a XXXXXXX & put in two Stents for 90% & 60 Blockage...Now wearing a lifevest by Zoll>> after 90 days of being protected by the Vest They intend to put in a Diferbultor >>She has a pacemaker now running at 70>>A combo will be put in>>This will only Protect against AFIB>> The last Ecko the heart was only running at 25% >> They are going to do another Ecko before moving forward We all do not expect the heart get over the 25%>> What can we do about THE HEART ONLY RUNNING AT 25% ?? Thank you in advance for you help XXXXXXX DiLemme
doctor
Answered by Dr. Rajaram KG 3 hours later
Brief Answer:
ICD implantation

Detailed Answer:
Hi, thanks for posting the concern in HCM.
My understanding is patients with an ejection fraction less than 30% are at a great risk of sudden cardiac death from ventricular arrhythmias, I.e. the rhythm abnormality of the ventricles in which ventricles or the output chamber of heart fails to pump out blood efficiently in accordance with the metabolic need of the body to the body tissues and organs. So previously the option was to prevent and treat this rhythm problem with antiarrhythmic medicines like amiodarone. Unfortunately, it couldn't significantly improve survival of those having EF < 25. Then the defibrillators were introduced and this is now the treatment of choice for your patient to improve survival and prevent sudden death. But, an Echocardiography is needed to ascertain that EF is actually low because usefulness of ICD (implantable cardiovertor defibrillator) is controversial above EF 30. So, the rationale of your treating doctors are absolutely correct and you just need to comply with them, as you've been doing for this long, and hope for the best. With successful ICD implantation, near about 90 percent of patients survive well for 2 years. We don't have sufficient evidence to predict survival for longer period. After implantation there will be specified restriction regarding activity or exertion, stress and diet and if you adhere to the advices specified by your doctor, survival will be improved.
If you are satisfied with the answer, please close the thread and rate my answer.
Regards,
Dr Kaushik Sarkar
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Rajaram KG 6 hours later
Thank you for your Info>>
Is there any meds that could help
the Straight of the the Hearts 25% EF

Here are a list of my wifes Meds Losartan 25mg >Crestor 20Mg>Tegretro 200mg>Imdur 30mg>Furosemide 40Mg> Synthroid 0.88>> Potassium 40mg>>Asprin 81mg
Still asking what we can do to up the 25% Ef??
Thanks again XXXXXXX DiLemme
doctor
Answered by Dr. Rajaram KG 15 hours later
Brief Answer:
Comply to the current regimen

Detailed Answer:
Thanks XXXXXXX for posting the medications. But, I am very sorry to say that you don't have other options.
I can understand the helplessness you are into at this stage. But, then also we have to think rationally.
So, let's discuss what can be done.
Look, the EF means how strongly the heart can eject or pump out the blood. Now, if your heart muscles are strong, they will eject with greater force. But, when there is blockage to the blood supply to this muscle, the cells die and the muscle becomes weak. And, here that's what has happened. Now, you can't make the dead soldiers alive. You can only strengthen the soldiers who are living for better outcomes. So, we give some medicines to prevent further progress of damage and some disease modifying medicines which have limited ability to improve disease status. Now, if you adhere to these medications and necessary lifestyle modifications, the disease won't progress or at least progress very slowly. Now, you need to prevent the complications that may arise from the compromised heart function. For this ICD is needed.
So, you can do only one thing, comply and adhere to the current treatment and I can assure you that you are having correct treatment for your beloved.
If you find this answer helpful, please rate it with thanks.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Rajaram KG 9 hours later
With the 25 % heart rate.It is working ok but it's just weak. Can my wife handle the surgery of the (implantable cardiovertor defibrillator) ?? XXXXXXX DiLemme
PPS Can I send you a copy of the results of the Echo?/& How??
doctor
Answered by Dr. Rajaram KG 24 hours later
Brief Answer:
surgery is the only option

Detailed Answer:
Hi, the thing is that your wife doesn't have 25% heart rate. Rather, the pumping capacity of her heart is 25%. Though there is substantial risk in any cardiac surgery, this surgery I mentioned before is the only option left to prevent sudden cardiac death now. It is now upto you whether you would take the risk.
The general condition of your wife would determine the survival chances in the surgery and it is not possible to predict beforehand.
You can definitely send me the scanned copy of the reports by attaching the soft copy in the reports section.
Wish her a good luck and good health.
Regards
Dr Kaushik Sarkar
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Rajaram KG 48 minutes later
A copy of the Ecko
[Procedure Note] (MARY DTLEMME] [5029J (10(17/2014J Page 1 of2 XXXXXXX Gotlieb, Saltzman, Edep and Brodsky, MD LLP
Procedu re Note
PMnt Name: XXXXXXX DILEMME
p~nt ID: 5029
Se':It: Female
llirthclatlil: January 13, J !il31
Primary Cate Provider: XXXXXXX Strool& MD
Referring PrClvidor: XXXXXXX StTobi!OMD
oet.ober 14, 2014
Mark B. Saltzman, MD XXXXXXX Got/leb, Salttman, EdI!:p ami Brodsky,
MDLLF
1000 NW 9th COurt SUite 20J.
.BOI:o Rator., FL 0000
(561} 395-4600
yjejt DilIm!
Prowider.
Location:
L.ocation Address:
Location Phone:
DEMOGMPHICS
Patient Data: 83 year old CaucasiM/Whlte femaloe:l
Height: 5 " :z ", Weight: 11.8 Ibs
Blood Pressurfl/: 110/60 mm Hg
PROTOCOL
A limited trensthoradc echo was performeo on to eV!'5luate the heart IiIrld as~;~ted strud'UI"eS. i'wo-dimerlSil)rlal, M-mode,.
and Doppler imi!l9in9 techniQues ware utilized. Imaging was 9cQuired in Pil~ern"llong and short axis, aPl~lr end subco5tel
vie'INS.
SOnographer: K"thlfin ~.owrY',RCS
rteferring ph'lfflk:lan: XXXXXXX Strobis MO
Attending Physi~n: Mark B. Saltzman, MD
Indication: t;F
MEASURENIi!NTS
lVIDd: 5.2 em. (NORMAL: 3.5 • 5.6 ern)
LVIDs: 4.4 0'0. (NORMAl: 2.8·4.0 em)
lVS: 1.0 em. (NORMAL: 0.1 • 1.1 em)
PW: 1.0 CITI. (NORMAL: 0.7 - 1.1 em)
Aortk: Root: 2.5 em. (NORMAL: 2.0· 3.8 em)
LA: 3.6 em. (NORMAL: 1.9 • 4.0 em)
FINDt.NGS
Teennleal qualltyl
The.image ouallty Is ~nico\llly adec!uate.
Left Ventritie:
Th@ LV Size is norma!. TIlli!re l$ nOtmai LV tl'lldC'l9SS. LV syslDlic function Is moderate glObai hypoklnesllO willi motion
"bnormbl!tle!! . Ovel'lillf left ventricular sy!!tol~ function IS modertltefy Oef}ressrxi with an ettimated e1ectlon fractlol"! of 25 %.
Right Ventrlc:lill:
The right ventricle j~ normal in size. RV thK:k:1~-Si$ normal. RV functiOrl i$ normal.
Left atrium:
The left atrium is norm~lln sua. There is no abnormal finding it) the left atrium.
Right atrium:
The right atliUl'R ts normal in SIZe.There is no abnonMI findIng in the right atrium.
Aortic: Velvet
[Digital Signature Validated]
10/17/2014 00:13 0000
(procedure Note] [MARY DILE:MME] [5029J
n,e Mlrtie valve i$ thickenecl.
(lOTL I EB EDEP ~IID PtlGE 02/(l2
[10/17/2014] Page 2 of 2
Mitral VaIVel
TIICiImitral valve snows mild thickening aod mitral anm.ilar cak:ffic8tkm .
Pulmonic Valve:
ihe pulmonic valVe appaan; ~rtJ(.turally IlIOrmai.
Tricuspid Valve:
The trtCUspid valve eppears itn.ld;urally normal.
~ricardium;
The pericardIum Is normal In appearance. There \; no signifICant I'ericareial ~fI'u!lion.
Aorta:
The aortic root appears normal In cilamete;.
JV(;=
The IVC is l"IOrmal in ca~ber.
CONCLUSIONS
LV systolic function Is normal. LVEF 25 O(~.
Addtional fil'!ding$ $$ alxMl.
cc: XXXXXXX Strob!s MD
flI..n.
Orders
o Ec:hocardiogram - Comphrte (93306) - •
GI«K'twnicslly SigMd bv: Mark B. SaltzmM, MD -Author OI~Octnber ii, 2014 09:36:39 AM
rDigital

Please take a look at this XXXXXXX DiLemme
doctor
Answered by Dr. Rajaram KG 13 hours later
Brief Answer:
Previous advice to be followed

Detailed Answer:
Thanks for posting the report.
As I can see here she has global hypokinesia, which is due to ischaemia.
EF was as stated correctly by you previously.
Now, my understanding is ICD is the option for her.
Look, after ischaemic injury to cardiac muscles, the wall motion lost cannot be reverted significantly with any medicine.
What we can do is to prevent disease progression and avoid complications.
ICD is to prevent complications like life threatening arrhythmia and sudden cardiac death.
Furthermore, your patient is 83 years old. ICD is particularly advocated for 75 yrs or older patients, because it has proven to improve survival most in these patients.
Obviously, as I have said previously, there are risks associated with any surgery and you have to make the choice.
Medicines will continue even after surgery to for resisting disease progression and prevention of complications.
Lastly, I am very sorry that I can't offer you the curative management because the condition has no cure. We can only halt it's progression and try to prevent its complications.
If you find this answer helpful, please close the thread and rate my answer.
Regards
Dr Kaushik Sarkar
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
default
Follow up: Dr. Rajaram KG 2 days later
I had asked this a few days ago It must of got lost in tranmission >>
After All the corrective Stent placements letting the blood flow through
the heart better. Will that help increase the heart pumping above the 25%
that it's at ?? XXXXXXX DiLemme Thanks in Advance
doctor
Answered by Dr. Rajaram KG 17 hours later
Brief Answer:
No, only further progress prevention

Detailed Answer:
Hi, thanks for posting again.
As I had told you before, stenting and medications would restore blood supply to affected portions, but the function once lost due to irreversible ischaemia (lack of blood supply) are lost for ever. So, pumping activity can't be improved further. Only complications can be prevented by ICD implantation and medications.
Regards
Dr Kaushik Sarkar
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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