Hello doctor,
My 72- year- old wife was diagnosed with permanent atrial fibrillation about eight years back. She had one echocardiogram four years ago, which showed mild chamber enlargement with normal ventricular function. I hope doctors will catch CHF or indications of remodeling or valvular issues while she is asymptomatic. Her BNP, three weeks ago, was 167 pg/mL. Would it be reasonable, medically necessary, or imperative for an echocardiogram to be ordered now? She is being rate controlled with 360 mg Diltiazem ER every day. In addition, she takes Sinemet, Levothyroxine, Quetiapine, Rasagiline, Apixaban, and Donepezil. Thank you.
Hi,
Welcome to icliniq.com.
Echocardiography done four years ago showed normal lv (left ventricular) function?. So yes, echocardiography should be ordered to see lv function, valvular structure, and chamber sizes. Moreover, if there is lv dysfunction so medicines may need to be modified, especially diltiazem. Further, I would advise lowering weight.
Regards.
Hello doctor,
Thank you for the reply.
We finally got a new echocardiogram. The most urgent query is who (what subspecialty of doctor) should I take my wife to now that we see LVEF 41%, PH>33 mm HG, and LA volume of about 130 ml? Does that seem to be HFrEF? Is the 41% any less significant than if we saw 41% HFpEF? The image quality of the report taken three years back is not good, so please let me know if you can read it. I will upload that first. They found one from a five-year report, but it does not have data, just conclusions. There are three images done six years back. Thank. you.
Hi,
Welcome back to iclinic.com.
Sir, if atrial fibrillation is permanent, there is no role in controlling or reverting rhythm, so ablation may not be an option here. Yes in paroxysmal and persistent af (atrial fibrillation), ablation is possible. Definition of permanent AF is when doctor and patient mutually decide that there will be no more attempt to revert rhythm, as there are no chances to revert.Regards.
Hi,
Thank you for the reply.
Your understanding of the meaning of permanent AF provides me with a new and beneficial perspective. More studies have been done on percutaneous ablation in the last two years, so that I will revisit the issue. My query was prematurely sent before I had a chance to complete my communication or upload the echo image files I have. May I, please, submit the three echo reports and expand the inquiry to you?
Thank you.
Hi,
Welcome back to icliniq.com.
Yes, you may put a query anytime, or you may have a chat with me. I will try to reply as soon as possible.
Regards.
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