My mother is a 69 year old type II diabetic with a history of "rheumatic fever" in her teens. She never had a heart symptom (but did have a heart murmur) until she took Pondimin for four months, when she went into atrial fibrillation. (This was just before all the information about phen-fen came out.) Until that time she was active though not athletic, traveling, gardening, etc. Since then, she has been in the hospital numerous times for a-fib and has been cardioverted several times (the last time requiring four shocks, increasing each time.) (Also, 24 hours after her last cardioversion, she went into congestive heart failure in a normal sinus rhythm.)
She just had her first heart cath and had some kind of vagal episode in the recovery room in which her heart rate dropped to 37 (reversed with atropine.) The doctors told us that her pressures were okay, but that she had a unique layout of her coronary arteries, probably congenital.("I've done 1500 of these, but I've never seen anything like this.")They didn't find significant blockages. She also has some heart enlargement and problems with the mitral valve. Her cardiologists recommended against valve replacement, saying "We could do the valve replacement and she could go into a-fib the next week, and stay there." So they are managing her with a cardiac rehab program, lanoxin, cardizem, coumadin, laxix, pravachol, K-dur, pacerone, altace, along with resulin and assorted hormones, laxatives, and vitamins.
My folks are in a very rural area. They have good insurance, but little money, energy, or inclination to travel to a major medical center for care. The situation is deteriorating. My mother is losing mental acuity and just had her first episode of burning pain radiating down the left arm and up her neck--this was several days after altace was added to her regimen. (The on-call physician she reported this to reassured her that it must be nothing, as no blockages were evident on the cath.) What I need to know is whether or not there are other treatment options that we should explore. Can consults be done without the patient actually having to travel to your clinic? I appreciate any advice you can give me.