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Doctors disagree
My husband had a heart attack in2007, following a hip replacement which became infected with MRSA. He was in the hospital at the time, and it went undiscovered for two days.  Previous to this, he had Afib for about 7 years.  He had a stent placed and after a long hospital stay, he was released on Plavix and other drugs.  He has had several bouts of shortness of breath and has been hospitalized several times since then for complications of MRSA which affected all of is major organs.  Las year he was realeased in July  and his primary put him on Coumadin , once more as he was released with blood clots in his legs and had had a pulmonary embolism.  In a checkup with the cardiologist she recommended he be put on Plavix which the primary disagrees with because she wants him on Coumadin.  He has CHF with an ejection rate of 33%.  He was born with only one kidney but it never has been a problem before but now seems to be getting a little worse all the time according to the nephrologist who wants him on Cozaart.  The primary says no because of his already low blood pressure high abot115/68    low about 106/58 (it has gone lower).  REcently he has started having Afib again fairly frequently and I am concerned.  He had some chest pain last week that he did not tell me about until afterwards. Could you please give me an opinion on medicines and tests to ask for(he has had an ekg)Thank you
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592969 tn?1248329005
Plavix works like aspirin.  It prevents the platelets from sticking together causing a blood clot.  Coumadin works differently and is for blood clots in the arteries and veins.  Coumadin is to be used with caution in people with CHF and he needs to be monitored very closely if he is taking Coumadin.  With CHF, ace inhibitors are best such as Lisinopril.  Ace inhibitors can also help reduce pressure in kidneys, lungs, and eyes (if glaucoma exists).  If the person cannot tolerate ace inhibitors because of allergic reaction then beta blockers such as Coreg would be best.  Coreg blocks more receptors to protect the heart than other beta blockers.  Some doctors put patients on both an ace inhibitor and beta blocker. If water retention is a problem, then a water pill will be needed.  It is dangerous to let to much water buildup especially if he has a weakened kidney. It is better to take water retention off little by little rather than letting it buildup to 20 or 30 pounds which is very dangerous for anyone with CHF.  His blood pressure of 115/68 or 106/58 is good for a person with CHF.  The blood pressure needs to stay down and usually below normal 120/72 is preferred with CHF.    Blood clots and water retention is the most concern with CHF.  He needs to be on a blood thinner to prevent the blood clots.  Plavix is the safer of the two, if it works for him.  Plavix does not work for everyone.  It's hard when doctors disagree.  Hope you get some answers from your doctors on what is best for him.  Take care.
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