Did my mother fell unconscious due to valve shrinkage?

Question

Hi doctor,

My mother is 71-years-old. She weighs 147.71 Lbs, and her height is 5.41 feet approximately. Four months ago, she fell suddenly and became unconscious while trying to pluck flowers in the garden. As soon as she fell, her forehead got injured and bleeding with a cut above the eyebrow. Immediately I splashed water on her face to make her conscious, and after two minutes, her consciousness returned. Right after that, we admitted her to the hospital for her forehead injury, where they took MRI (Magnetic Resonance Imaging) and CT(Computed Tomography) scan and declared no issues with the brain. After two hours of admission, she reported chest pain due to the fall. So echocardiogram was taken. Based on the report, the treating doctors said there is a 70 % probability of valve shrinkage but could not confirm that. Then they placed her under Holter monitor for 48 hours. A cardio CT and echocardiogram were retaken, and valve shrinkage was again diagnosed but not confirmed. The doctor suggested valve replacement surgery as the treatment. Her blood pressure on the day of the incident and the following five days was 180/110 mm Hg. We had a second opinion regarding my mother's heart condition with another doctor. He also ordered an echocardiogram and said that valve shrinkage was present. He also put her under a Holter monitor for three days and suggested the same treatment. Thirdly, we consulted another doctor, who took an echocardiogram and said that while viewing from one side, valve shrinkage was present while it is not while considering from the other side. He also suggested a neurologist's opinion, which is awaited. She also has a history of falls two to three times previously, but she was conscious and aware of her falls. She is taking medications for rheumatoid arthritis and has taken medication for nerve problems since 15 days before the fall. She has been taking drugs prescribed by her treating doctor since the incident. I have attached all the reports and prescriptions for your reference. We are ready to have valve replacement surgery, but could you please let us know the reason for her fall and subsequent loss of consciousness? Also, is the valve shrinkage present? If so, how much? Is valve replacement surgery the only option? Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern. I have gone through the reports (attachment removed to protect the patient's identity). There are two reports, one with severe aortic stenosis and the other with moderate aortic stenosis. Based on the first report of severe aortic stenosis and her loss of consciousness, the likely cause is aortic stenosis only (valve shrinkage), and I suggest valve replacement for the same. And if we see other reports that mention moderate valve shrinkage, the aortic valve area mentioned is 1 cm², which is relatively low. And with this valve area, along with loss of consciousness episodes, it is better to subject her to valve replacement. Based on symptoms and standard neurological tests, severe aortic stenosis reports appear more accurate (valve shrinkage) than the report of moderate aortic stenosis. Your mother's symptoms are due to valve shrinkage, based on an abnormal echocardiography report and unremarkable other tests. Kindly revert in case of further queries.