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Aortic valve replacement: how soon?
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Aortic valve replacement: how soon?

My 81-year-old mother, still in the hospital, was just diagnosed with congestive heart failure (CHF) based upon fluid in her lungs, ankle and leg swelling and pain and shortness of breath, all worsening over a few days. Upon admission they found more fluid in her lungs and elevated cardiac enzymes suggestive of a mild heart attack. Yesterday a doctor told me she was diagnosed over a year ago in the same hospital with moderate to severe narrowing of the aortic valve.  She says she was not told of this diagnosis (it is possible she doesn't remember, it was a very stressful period with my brother also ill at the time). She was given no cardiac care or meds this past year. Her PCP seems unaware, and he reacted to her complain of sudden dyspnea and swelling by sending her home with an inhaler and suggesting it was anxiety. Even when an x-ray revealed fluid in lungs he just said to get some lasix pills, never said a word about heart failure.

She says now she may be sent home tomorrow, as her lungs have cleared the fluid (3 lbs worth) after 2 days of IV lasix. She has still not met with a cardiac specialist, although I imagine she will see one today following an echocardiogram scheduled this p.m.

What questions should I ask her cardiologist?  What should we know before discharge?  How soon may she require surgery?  If they send her home, what type of follow up is recommended?  It would appear she can't or won't follow up on her own, and her PCP appears to be incompetent or to be charitable, perhaps overworked.
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Avatar_dr_m_tn
Hi,
Probably, your mother is suffering from age related aortic stenosis which usually initially presents as chest pain but later may go on to progress as heart failure. The prognosis after the valve replacement usually is quite good. You can ask the following questions from the cardiologist.

1. Does she need surgery or will the medical therapy suffice? Her old age has also to be taken into account.
2. Does she need a coronary angiography to see the status of coronary arteries (the arteries which supply blood to the heart).
3. The prognosis depends a lot on the status of ejection fraction which means how much blood is being pumped out by the heart and also the status of the coronary arteries.
4. You have to take care of her fluid intake and salt intake and both have to be restricted as they tend to worsen the heart failure. Excessive exertion can be detrimental to the heart.
5. She will need a regular follow up and repeated echocardiography to see how well her heart is performing.

I sincerely hope that helps. Please do keep me posted. Kind regards.
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