Scary Setback To My Heart Valve Replacement Surgery

[Mobi]

I am now into the 7^th week since I had my aortic valve replaced and apart from annoying high blood pressure and a high pulse rate everything seemed to be going pretty well.

Then last week I noticed some heart palpitations but didn’t think too much about it, but last Monday night my heart went into overdrive.

My heart rate was running up to 140 beats/mins and when my BP machine didn’t keep coming up with error messages, I found that my BP was all over the place. I thought it might settle down after an hour or so, but it kept getting worse and by 3 a.m I was feeling pretty bad. I was having an acute atrial fibrillation.

My GF drove me to Pattaya Memorial hospital, and to cut a long and very frustrating story short, when they finally understood that I wasn’t just ‘excited’, they took an EKG and discovered my heart was very in a very unstable state, and started to take me seriously. The doc gave me a beta blocker which had no effect whatsoever, and eventually gave me Lanoxin, (used for congestive heart failure) and told me to go home and to monitor my condition.

My heart was still in serious cardiac arrhythmia when I got home but I eventually fell asleep from exhaustion and when I woke a few hours later, it had stabilised, but still wasn’t normal.

Anyway, I hung on till yesterday afternoon when at long last I saw a Cardiologist. He looked at my EKG and told me I was given the wrong medication and put me on an intravenous drip of amiodarone, and kept me there for a couple of hours to make sure I could tolerate the drug and then sent me home with a an oral supply of the same meds.

I showed the doc my BP records which showed a consistently high BP and heart rate since my operation and he couldn’t understand why my surgeon had not prescribed any BP reducing meds. I have read that it is quite common for such meds to be prescribed for the first six months or so after valve replacement surgery.

Anyway, I am now much more stable and my BP is lower than it has been at any time since the operation and my heart rate is much better.

I guess it’s just one of life’s ‘trade-offs’ of living in a place like Pattaya where the only expert medical help available is likely to bankrupt you before you are cured. (Yes, I refused to go to BPH – I’d rather die than have those mercenary bastards rub their hands in glee and take me for a small fortune.)

The cardiologist is based at Queen Sirikit Hospital but does a weekly 2 hours stint at Pattaya Memorial . He seems to know his stuff, so fingers crossed.

[kevjohn]

Glad all seems well now.

Take care.

[Rimmer]

Oh good grief, what a thing to happen after all you have been through

[ddpffft]

dont drink grapefruit juice

en.wikipedia.org/wiki/Amiodarone

[craigt3365]

Wow. Quite the experience. Thanks for keeping us updated. Hang in there and look forward to seeing you soon!!!!!!!!!

[meatboy]

sorry mobi i was going to ask you early on how you were,this is what i am on,

bisoprolol,

amlodipine

perinapril

i understand all these control the problems you are experiencing,how is your inr.

[Sheryl]

Glad it turned out alright. Best to have regular checks with the cardiologist.

[sbk]

My dad had a-fib and yes, ditto on the grapejuice. It is possible to keep it under control, sounds like the cardiologist knows his stuff, keep up the checks and make sure your meds are monitored,

[harrry]

Glad your ok.....cannot have the website stopping.

[Mobi]

sorry mobi i was going to ask you early on how you were,this is what i am on,

bisoprolol,

amlodipine

perinapril

i understand all these control the problems you are experiencing,how is your inr.

Your meds are basically ace inhibitors and beta blockers. I'm now on something a bit stronger, specially designed to prevent another arrhythmia attack.

Maybe if they'd given me more BP reducing drugs and beta blockers in the first place, it wouldn't have happened. Who knows? I'm not a doctor.

(BTW I was taking Amlodipine - the only drug that was prescribed.)

My INR was 2.53 but haven't checked for several weeks so will do so next week before I see the doc.

[Jingthing]

That was a gripping report. Thanks for telling us about it.

[Mobi]

Here is an update on the saga of my A-Fib attack following heart valve replacement surgery.

It is now 2 ½ months since I had my A-Fib, and after fluffing around for a while, I eventually settled for a highly qualified cardiologist at BPH who I have been seeing for the past 2 months.

The doc certainly knows his stuff, and he changed my A-Fib prevention med from Amiodarone to Tabocor (Flecainide), 100mg per day.

But - sad to report, -every time I went to see him, he couldn’t remember anything about my case, didn’t even bother to review the records in front of him, or those I brought with me, and kept asking me how long was I on holiday and when would I be going back to the UK?

I’ve really had to push him hard to take any interest in my condition, more or less forcing him to give me an opinion on my current medical situation, after thrusting my BP records and INR results in front of him.

My INR is still all over the place but my BP is pretty stable and he told me to maintain all my current meds, after busily jotting them down from a list I provided. (He does this every time, even though he already has the details from my last visit)

‘Keep taking everything?’ I asked him.

‘Yes.’

‘What about the Flecainide?’

‘Oh! Why do you take that?’ he asked, peering closer at my list.

‘For my A-Fib – you remember? That’s why I came to see you in the first place?’

‘Who prescribed Flecainide?’

‘You did!

‘Oh, really? So have you had any more A-Fibs?

‘No.’

‘So you can stop taking it!’

I am anxious to have an informed opinion about whether or not I can stop taking this medication, because ever since I had the A-Fib, I haven’t been able to get back to my former levels of fitness and I always seem to feel lethargic and tired. I am also a little unsteady on my feet – not dramatically so, but enough to notice. I have read that all these symptoms are possible side effects of Flecainide, so I want to see if they disappear if I stop taking it.

However, I would hate for me to have another A-fib, as it was very scary.

Quite frankly I have lost any confidence in this doctor giving me the correct advice as he just doesn't seem to care.

Does anyone happen to know whether A-fibs that occur after aortic valve replacement tend to disappear after a few months, or do they continue indefinitely?

I have Googled but can find no specific info on how long I may be susceptible to A-fibs following valve replacement surgery and how long I should continue to take this med. For most people suffering from A-Fibs, it is a life-long condition, but not so, (I think), for people like me.

Anyone have any informed views on this?

[jrtmedic]

Mobi

I suspect you know about most of the following !

Flecainide is used to prevent or treat irregular heartbeats (arrhythmias) such as paroxysmal supraventricular tachycardia (PSVT) and paroxysmal atrial fibrillation/flutter (PAF). Flecainide is also used to prevent life-threatening sustained ventricular tachycardia (sustained VT).

Because of the proarrhythmic (Arrhythmia causing) effects of Flecainide, its use is usually reserved for patients in whom, in the opinion of the physician, the benefits of treatment outweigh the risks.

In your case I would suggest you attempt to find a Cardiologist in whom you have confidence. Clearly this should be someone who is prepared to take an interest, discuss and explain your case.

As your AF is likely to be associated with recent surgery or, more likely , uncontrolled high blood pressure, you may find that the need for an anti- arrhythmic medication decreases over time.

Control of blood pressure is important as uncontrolled high blood pressure can be a cause of AF. Getting some control over your INR is also important and may require more frequent testing and medication adjustment until the results stabilise within an acceptable range.

I am just attempting to provide you with some information which may be helpful. There is no substitute for well informed medical advise which is based an a thorough understanding of your situation.

Best wishes

John

Edited October 17, 2012 by jrtmedic

[meatboy]

sorry to hear your finding it hard to get back to normallity but it did take me quite a long time exp.with getting the inr right,if its still all over the place have a test every 2-3 weeks,dont know if i posted before there are certain fruits you must keep clear of,cranberry,grabefruit

this could mean pomellon and try to avoid citrus before a test.regarding the unsteadeness on your feet i used to have giddy spells quite often and had to sit down or rest if walking only took a few minutes to pass i have only had about half a dozen the last three years,in fact one was last week.i to have experrianced seeing a doctor who couldnt remember my problems back in the uk.the last time i said enough is enough when he told me to stop smoking.[never smoked a fag in my life]

[cheeryble]

Hi Mobi

Regarding the first episode 2 plus months ago.

You ended up feeling bad enough to go to hospital.

From the sounds of it it may have had elements of a panic attack.

This alone would be enough to make you feel genuinely ill and cycle up into higher BP and so on.

Just suggesting that you may not have been as ill as you thought......even a minor hiccup of a few palpitations might have been enough to build up into something with very measurable symptoms that made you feel anxious and terrible. (one of the common complaints of panic attack patients is that they are "having a heart attack). What I am saying is the anxiety alone can make you feel very ill.

Naturally this is not a suggestion to reduce monitoring or treatment......

Bon chance and see you at 90.

[Mobi]

Thanks for the replies, gentlemen, they have been most informative.

There seems little doubt that the arrhythmia was a result of my valve replacement surgery. It is a very common occurrence following this kind of surgery usually early on, but it can occur some weeks later, as it did in my case, and my surgeon even expressed surprise that I didn't have any arrhythmias in the few days following the surgery.

Neither of the two cardiologists I have since consulted expressed any doubts that the A-Fib was due to my operation. My heart rate was all over the place, as was my BP, and The EKG looked really scary. Indeed the doc who initially attended me in A&E thought it might be some kind of panic attack until he took a look at the EKG, and it was so bad that he kept me hooked up to it to monitor my condition.

I am checking my INR weekly and trying to adjust the medication to stabilise it - so far with limited success - it is either too high or too low.

With judicious use of drugs, including a low dosage beta blocker, I have been having much better luck with my BP which is more stable than it has been for a long time, only rising late at night when the effect of my various meds wears off.

John, of course you are correct on everything you say. Indeed your comments on having high BP may also be partly valid as a cause, as post op, my BP was very high but when I showed the BP log to my surgeon, 1 month after the op, she didn’t prescribe any BP reducing meds, even though I had been on many such drugs before the operation. Your advice on finding a good caring cardiologist is also good sense, but I continue to have no luck whatsoever in finding one, regardless of hospital or cost. I guess it's one of the risks of living in a place like Pattaya; hence my search for informed advice elsewhere.

In the absence of any advice to the contrary and as my BP is now pretty stable, I think I will wean myself off Flecainide from the start of next month and see what happens....