Rheumatic heart disease (1)
1.What is the heart murmur? Zheng Xiaozhou, Cardiovascular Surgery Department, Jinan Military General Hospital, Jinan, China A: There are several possibilities for heart murmurs: first, some normal people have a slight systolic murmur; second, the manifestation of congenital heart disease; third, rheumatic heart disease or other heart valve disease; fourth, other heart diseases such as hypertrophic cardiomyopathy. Therefore, if the doctor hears a clear heart murmur, it is best to go to the hospital for an ultrasound examination. ||
2.Does all rheumatic heart disease require surgery? A: Most rheumatic heart disease has an asymptomatic period of many years. Patients do not experience any significant discomfort during this period. Generally speaking, this period can be observed or maintained with a small amount of medication under the guidance of a doctor. Patients with combined atrial fibrillation should be treated with anticoagulation. Aggressive treatment such as surgery or mitral balloon dilatation should be considered in cases of decreased physical strength, inability to tolerate heavy work or physical activity, difficulty getting over colds or colds, swollen feet, and chest tightness at night when sleeping flat. ||
3.Do I have to take anticoagulants after valve replacement surgery? How expensive is Warfarin? A: Because of the possibility of thrombosis at the replaced valve after valve replacement, anticoagulants must be taken after valve replacement, lifetime anticoagulation therapy for mechanical valves and six months for biological valves. Those with atrial fibrillation are on lifelong anticoagulation therapy. The anticoagulant used is almost always Warfarin (some trade names may not be the same). It should be taken only once a day at regular intervals, but should not be stopped or increased or decreased at will. More patients take a dose of about 3 mg, and the current price of imported drugs such as Finnish Warfarin is about 70 cents per 3 mg tablet, which may cost more than 20 dollars per month. Domestic Warfarin is cheaper, around 2.5 mg and 30 cents per tablet. Other treatment costs also include regular rechecking of blood anticoagulation such as INR (some places prefer PT), which is recommended at least quarterly if the disease is stable and costs about $20 each time. ||
4.What are the side effects of taking too much or too little of Warfarin? Is it resistant to the drug after taking it for a long time? A: The doctor will adjust a suitable dose according to each patient’s specific situation after the flap replacement surgery. If there is no significant fluctuation in the results of the review later, take it for a long time. There is no problem of drug resistance yet. The amount of Warfarin may not be enough to prevent thrombosis, but more may cause bleeding such as nosebleeds and stool bleeding. ||
5.What should I pay attention to when taking Warfarin? Can’t I eat green vegetables? A: Some foods or drugs have some effect on Warfarin, it is recommended that patients taking the drug read more books on the subject, and those containing more vitamin K will reduce the effect of Warfarin. Such as most green-colored foods. Some drugs such as aspirin and most anti-inflammatory drugs may increase the effect of Warfarin. But not all of these foods or drugs can not be used. For example, if the food, if you can maintain a balanced diet (such as not always eat green vegetables at one time and eat very little at another time). Warfarin dosage does not necessarily need to be adjusted. If you need to use other drugs, you can pay attention to the blood INR during the process of medication. make some necessary adjustments will be fine. You should also remind your doctor that you are taking Warfarin, so that they can make appropriate arrangements for the medication or other procedures.
Rheumatic heart disease (2)
6.Can I get pregnant if I take Warfarin? A: Warfarin can have an effect on the fetus. However, if you really have a strong desire to have a child, there are still ways to deal with it. However, this situation needs to be adjusted under the guidance of a professional doctor. There are some patients who had healthy babies after flap replacement, and the mother and child are safe. ||
7.How many years can I live after valve replacement? A: As far as the valve itself is concerned, it can last for decades without rusting, severe wear and tear, etc., except for a few genuine quality problems (very rare). Problems can occur because of improper use of the valve, resulting in thrombosis or bleeding in other parts of the heart, such as cerebral hemorrhage, combined infective endocarditis, or perivalvular leakage due to rheumatic activity. In some cases, patients who have had their valves replaced too late or who have other heart disease may have severe damage to the heart muscle and still have heart failure after surgery. Therefore, the quality of life and life expectancy after surgery should not be pessimistic if one takes care of the body. ||
8.Is it better to replace the bioprosthetic valve or the mechanical valve? A: If there is no atrial fibrillation after six months after biologic valve surgery, it can be easier to control without anticoagulants, even when taking anticoagulants. It is also good for the patient’s cardiac function and so on. The disadvantage is that the biologic valve has aging problems, and the average life expectancy of a biologic valve is currently estimated to be more than 10 years. This means that after 10 years the valve may have to be replaced again due to aging. Mechanical valves have a very long life span. However, it is necessary to take strict warfarin. The difference in cost between the two types of surgery is not too great. Therefore, in general, older patients without atrial fibrillation can consider replacing the biologic valve, while young and middle-aged patients with limited financial resources are recommended to replace the mechanical valve. ||
9.How much difference is there between domestic and imported valves and between domestic and imported valves? A: Imported valves have relatively good technology, in the same anticoagulant did not control the conditions, the possibility of thrombosis imported flap is relatively small; some imported flap switch sound than the domestic flap to be smaller; imported flap has a double leaflet flap similar to double doors than the domestic flap of a single leaflet flap similar to a single door on the impact of blood flow to be smaller, some heart conditions domestic flap is not very suitable. Imported Chinese decree than the domestic slightly more expensive, better stability. ||
10, I am now poor health can surgery? A: There are many patients with wind heart disease who are unable to perform daily life for a long time, but it cannot be said that they cannot have surgery. Before surgery, the doctor will make an overall assessment based on the patient’s specific conditions such as heart structure, liver function and kidney function. It should be said that the vast majority of patients still have the opportunity to operate. Of course, the difficulty and cost of surgery may be higher for patients who are too severe. Patients with poor heart function, liver function or other organ abnormalities will need to be adjusted for a period of time prior to surgery. ||
11.How much does it cost to replace the valve? A: The cost of treatment varies from patient to patient. In terms of total hospitalization cost, it is about 50,000 RMB to replace one domestic valve. For two domestic flaps or one imported flap, it is about 60,000 yuan. The replacement of two imported valves may cost about 80,000 yuan. Patients who need three flaps are rare.