Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hello doctor,
My mother is 59 years old and has mitral stenosis. CMV was done 35 years back. Now recently she had a heartbeat of 150 beats per minute and atrial flutter, and she was on Acitrom previously. She has undergone DC cardioversion shock. Now latest ECG shows atrial ectopic and her heart rate is 70 to 80 beats per minute. Can she undergo an operation soon? If yes, which valve would be best for her biological or mechanical? Which is the best and latest generation biological valve in the world market?
Kindly help.
Hello,
Welcome to icliniq.com.
Thank you for your query.
Yes, she is now a candidate for mitral valve replacement. However, you should make a note that valve replacement is not a complete solution. Firstly, at this age, a mechanical valve is better considering the durability of the valve. The bileaflet valve is the preferred one. Next, she has to be on regular blood thinners. Otherwise, there is a risk of valve dysfunction which may lead to a repeat surgery if blood is not adequately thinned. Also, this heartbeat problem may not go even after valve replacement and has to be controlled with medicines. Even now she should be on beta blockers like Metoprolol, then Diltiazem to keep her heart rate controlled, which are quite effective.
I hope this helps you get back if you have any doubts.
Patient's Query
Hello doctor,
Some CTVS surgeons previously advised the biological valve. He told that although it is said mechanical valve lasts longer, in practice, it is seen that these valves show lots of complications and patients even die due to that. So he told biological valve is better. Is it true?
Hello,
Welcome back to icliniq.com.
The durability of the bioprosthetic valve is less and may need repeat surgery after 10 to 12 years. So, in our case, we prefer mechanical valves before 65 years of age. So, you need to understand the pros and cons of both. Also, if she has some bleeding risk or tendencies, then she will need a bioprosthetic valve. Otherwise, in healthy individuals of this age, who can take regular medicines and do routine tests, the mechanical valve has a slight upper hand.
I hope this has helped you. Thank you.
Patient's Query
Hello doctor,
My mother was admitted to the hospital with palpitations and was diagnosed with AVNRT and was treated by IV Amiodarone. It was discharged from the hospital 14 days back with Amiodarone 100 mg BD and metoprolol 50 mg OD. Amiodarone was omitted from the last two days as per the doctor. But she was okay till yesterday morning. But since yesterday afternoon she's having bradycardia. Heart rate sometimes goes below 35 for a few seconds. Please see the last lines of the ECG. Please see the attached ECG reports.
Kindly help.
Hello,
Welcome back to icliniq.com
ECG shows frequent atrial ectopics. Atrial ectopic is followed by a compensatory pause. We have to see the overall heart rate in a minute, not just for seconds. In Ecg, her heart rate is to be fine and not low. So, count her heart rate in a minute, and if less than 60 bpm then it suggests bradycardia. If it is bradycardia then a dose of Metoprolol may need to be reduced. Now regarding arrhythmia, it may be AVNRT or may be atrial fibrillation with a fast ventricular rate. These are quite common in valve patients and may occur repeatedly in the future as well. These are not life-threatening arrhythmia and can be well dealt with by medicines. She will need long-term Amiodarone or Metoprolol to control her heart rate and blood thinners.
Hope this helps you get back if you have any doubts.
Patient's Query
Hello doctor,
She is taking 12.5 mg of Metoprolol BD or TDS. Should she increase the dose? Which form of Metoprolol she should take? Plain or sustained release? She was taking Amiodarone 100 mg BD before for the last 14 days and was stopped a few days back as per the doctor. Shall she start Amiodarone again? At what dose?
Kindly help.
Hello,
Welcome to icliniq.com.
Her heart rate was fine in ECG. So, if I have to go by ECG, she should continue with the same dose of Metoprolol. It is better to have a sustained release formulation. In my opinion, better to continue amiodarone at least 100 mg once a day to prevent recurrences of atrial fibrillation, if the heart rate per minute is not going too low.
I hope this has helped you. Thank you.
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