Patient's Query
Hello doctor,
My mother is 59 years old and has mitral stenosis. She underwent CMV (closed mitral valvotomy) 35 years ago. Recently, she experienced a heart rate of 150 beats per minute and atrial flutter. She was previously on Acenocoumarol. She has since undergone DC cardioversion. Her latest ECG shows atrial ectopic beats, and her heart rate is now 70 to 80 beats per minute.
Can she undergo surgery soon? If yes, which type of valve replacement would be better for her — biological or mechanical? Additionally, which is considered the best and latest-generation biological valve available in the global market?
Kindly help.
Hello,
Welcome to icliniq.com.
Yes, she is now a candidate for mitral valve replacement. However, it is important to note that valve replacement is not a complete solution. Firstly, at her age, a mechanical valve is generally preferred due to its durability. The bileaflet mechanical valve is the most commonly recommended option. Secondly, she will need to be on regular blood thinners to prevent complications. Without proper anticoagulation, there is a risk of valve dysfunction, which could necessitate repeat surgery if the blood is not adequately thinned.
Additionally, her heartbeat irregularities may persist even after valve replacement and will need to be managed with medications. Currently, she should be on beta-blockers, such as Metoprolol, followed by calcium channel blockers like Diltiazem, to help control her heart rate. These medications are effective in managing heart rate issues.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Some CTVS surgeons previously recommended a biological valve. They mentioned that although mechanical valves are said to last longer, in practice, they often lead to various complications, and in some cases, patients even die due to these issues. Therefore, they suggested that a biological valve might be a better option. Is this true?
Hello,
Welcome back to icliniq.com.
The durability of a bioprosthetic valve is lower and may require repeat surgery after 10 to 12 years. Therefore, in patients under 65 years of age, we typically prefer mechanical valves. It is important to understand the pros and cons of both options.
If she has any bleeding risks or tendencies, a bioprosthetic valve would be the better choice. However, for otherwise healthy individuals of this age who can adhere to regular medication and routine testing, a mechanical valve has a slight advantage.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
My mother was admitted to the hospital with palpitations and was diagnosed with AVNRT (atrioventricular nodal reentrant tachycardia). She was treated with IV Amiodarone and discharged 14 days ago on Amiodarone 100 mg twice daily and Metoprolol 50 mg once daily. Amiodarone was discontinued two days ago as per the doctor’s advice. She was stable until yesterday morning, but since yesterday afternoon, she has been experiencing bradycardia. Her heart rate occasionally drops below 35 beats per minute for a few seconds.
Please review the last lines of the ECG and the attached ECG reports.
Hello,
Welcome back to icliniq.com
The ECG shows (attachments removed to protect the patient’s identity) frequent atrial ectopics, each followed by a compensatory pause. It is important to assess the overall heart rate per minute, not just for a few seconds. In the ECG, her heart rate appears fine and not excessively low. Count her heart rate over a full minute, and if it is less than 60 bpm, it suggests bradycardia. If bradycardia is confirmed, the dose of Metoprolol may need to be reduced.
As for the arrhythmia, it could be AVNRT (atrioventricular nodal reentrant tachycardia) or possibly atrial fibrillation with a fast ventricular rate. These conditions are quite common in valve patients and may recur in the future. However, they are not life-threatening and can be effectively managed with medications. Long-term treatment with Amiodarone or Metoprolol may be required to control her heart rate, along with blood thinners to reduce the risk of complications.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
She is currently taking 12.5 mg of Metoprolol twice or three times daily. Should the dose be increased? Which form of Metoprolol would be more suitable for her, plain or sustained release?
She had been taking Amiodarone 100 mg twice daily for the past 14 days, but it was discontinued a few days ago as per the doctor’s advice. Should she restart Amiodarone? If so, at what dose?
Hello,
Welcome back to icliniq.com.
Her heart rate appeared normal on the ECG. Based on this, she should continue with the same dose of Metoprolol. A sustained-release formulation is preferable for better effect.
In my opinion, it would be better to continue Amiodarone at a dose of at least 100 mg once daily to prevent recurrences of atrial fibrillation, provided her heart rate does not drop too low.
I hope this has helped you.
Thank you.
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Answered byDr. Sagar Ramesh Makode
Medically reviewed byDr. Nithila. A
Same symptoms don't mean you have the same problem. Consult a doctor now!
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