high coumidin, PVC's, Ejection Fraction,tricuspid valve defect, problems

I am a 43 year old female with 3 small children at home.  I am 5'7 and 140 lbs. I exercise daily (usually walking 2-3 miles.)  I was reletivly healthy until 3 mths ago.  I had chest pain at work that traveled up my neck and down my arm.  I waited 3 days until I went to the hospital because I was still having this pinching sensation in my chest.  They found elevated troponin levels and I was having PVC's.  I was given a stress test (normal) and a heart cath. (normal)  a week after my heart cath. my right isiliac vein collapsed and they had to stent my vein.  I was put on Coumidin.  Today I take 20mg of coumidin and lovenox shots and am still not therapudic. protime is 1.73  I go to a hemotologist on the 22nd of June.  I also just had a echocardiogram done as a follow-up.  They found I have only 2 valves on my tricuspid and a hole i my heart.  Also my ejection fraction rate is about 50%  What should I be doing.  Should I persue going to the Cleveland Clinic?

[Jerry_NJ]

You clearly need to reach an informed decision driven by consultation with your doctor(s)... all we can do here is sympathize and tell you our personal stories.

Some observations:
1) I don't understand why you are on coumadin, and at such a high dose yet have, what I take to be your INR of 1.733.  I run between 2 and 3 with 5 mg of Warfarin.  That is the therapudic range for AFib.  AFib is associated with a higher risk of clot formation, PVCs are not in my knowledge.
2) an EF of 50% is low, but not critically low to my understanding.  I think 65% is about a good as it gets.. some may be better, but not over 70%.
3) Cleveland Clinic is one of the best and they do offer web-based (mail) consultation for a reasonable fee (I have not used).  They will examine your medical data and give a medical second opinion.
4) the valve trouble may not need to be treated, but I'd think the hole would need to be repaired and that may increase your EF.  I think that type of operation can be done without opening the chest (catheters or robotics).  
5) your young age and reasonable physical fitness (as you describe it) are strong factors in your favor.   You should respond and recover well from whatever has to be done.

Good luck, and give us the good news as it develops.

[martagonz]

I am your same age and height but I am overweight (160pounds) and I have EF of almost 70% and mitral valve prolapse.  I go to a cardiologist twice a year and take 2 meds for high blood pressure and arrythmias.  I suggest you go to a better cardiologist, I thing Cleveland Clinic would be great if you are in the area.  You would probably need valve repair and it's better to do it when you are young and relatively healthy.  God bless you and hope you get better soon!

[LindaTX]

Sorry you are having all this trouble.  I, Like Jerry am on coumadin and stay in the theraputic range of 2-3 with a 5mg tab a day.  Are you positive it's 20 mg and not 2 mg?  Especially when you add the lovenox shots.  I know there is a certain % of people who can't do the coumadin because of erratic levels.  You might check out the dtails on that to see if you might fall into that group. Are you still walking 2-3 mi a day?  Did the Dr put you on a beta-blocker or any other heart meds?  If I were you, because of your valve issue, I think if I lived as close to the CC as you do, I'd go there.  It has a reputation for being the best.

[kiki413]

thank you for your response.  I am positive it is 20mg.  They have just increased me to 22mg plus lovenox.  They do want me to take a beta blocker, but I have not started it yet because my blood pressure has been running low.  I meet with a hemotologist on the 22nd.  I will probably ask my primary dr. for a referral soon.

[LindaTX]

Sounds like you have a good plan.  Good Luck and keep us posted  :)