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Re: Aortic valve replacement

Posted By CCF CARDIO MD-APS on September 14, 1998 at 11:03:21:

In Reply to: Aortic valve replacement posted by erin on September 09, 1998 at 21:28:03:

In august 1997, my mother had a heart attack, but was not treated at the time.  Subsequently, she felt "odd" and went to a cardiologist who diagnosed a heart attack and after various tests said that the aortic valve was not working properly.  My mother has never had a major illnes or hospital stay.  She exercised regularly, never smoked, and drank moderately.  She has never been overweight.  As of now she is on the following medications:  beta blocker; Evista; Norvasc; Nitro Dur; a daily aspirin.  Her physiological age is early 70's.  She lives alone, drives, shops, does housework, crossword puzzles, and is twice a sharp mentally as most people half her age.  She is 89 years old with a feisty personality.  The doctors here have told her that she is too old for surgery.  I realize that she may not have many years left, but I wonder about the appropriateness of the medication, and if an operation is possible (or desirable)?  She thinks the Evista is making her feel bad, but has followed her doctor's recommendations.  we are in a small town, but about 2 hours from Duke University.  Would it be worthwhile to seek a second opinion there?  Do you have any advicecomments on her medications and on the advisability of an operation?  Thank you for your help!!


Dear Erin,
Yes a second opinion at Duke University would be a great idea, a second opinion
in general is always a good idea.  For two reasons your mother will benefit from
an opinion at Duke: (1)This is a place that is most likely to do high risk surgeries
which your mother is because of her age, thus if the Duke surgeons say no, ask
them specifically why (for example, often the elderly have very calcified aortas
that place them at very high risk for stroke if they undergo open heart surgery)
and if they say no, it is unlikely and not good advice to go searching the country
for a place that will, and (2) Since your mother will probably greatly benefit from
medical therapy (see next paragraph) it is very important that she be treated, that
her therapy be overseen by a geriatrician.  Geriatrics is a subspecialty of internal
medicine, and these physiscians are very good at helping to maintain the best
possible quality of life for the elderly patient; sometimes all this takes is
switching around medications to find the ones with the least side effects that
still do the job, so to speak.
Erin, there are many patients that live for years with an incompetent aortic valve
and without symptoms.  Of course those on medical therapy are less symptomatic and
there heart deteriorates at a much slower rate.  Given the risk of surgery to your
mother based on her age alone and the low risk with medical therapy, it is probably
the best opinion to give medications a good trial at keeping your mother active and
her heart happy.  The second opinion at Duke as well a consult with a geriatrician
are in your mother's best interest.  I would like not to comment on her medications
as I do not really know her condition and results of cardiac testing.  Although I
will say that no person should stay on any drug that they believe is interfering significantly
with their quality of life, and your mother should be told that just because the doctor prescribed
it doesn't mean she won't live if she doesn't take it.  Of course one should never stop a medication
without informing their physician.  Keep in mind that Duke U. Hospital is at the forefront
of cardiology care and their review of your mothers cardiac health will be very useful, informative,
and at least you know that she will have been offered the best available medical cardiac care there is!
Also you should know that there are so many different classes of cariac drugs availble today to cardiologists
that it is very unusual that a cardiologist and or geriatrician is unable to find a combination of drugs
for someone such as your mother that do not impede on her qualtiy of life.  Unfortunately, you do need to
realize now that your mother is not the same as she was just a year ago, she has heart disease and this
as well as her taking medications will be with her for life.  Good Luck.
Information provided in the heart forum is intended for general medical informational
purposes only, actual diagnosis and treatment can only be made by your physician(s).

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