Getting it right

[amy]

My husband received a St. Judes valve in the aortic position on July 24. The surgery went without a hitch and he was sent home 5 days later with good coumadin levels. He went to the cardiologist to check levels two days later and they were fine. Three days later, he saw the cardiologist for a post op check and coumadin levels. They were fine. The following day, he was getting more winded and didn't look right to me but my husband insisted he was ok. The following day, he looked even wors. I ended up forcing him to go to the ER. His coumadin range should be 2.5 -3.5. When we got to the ER, he had fluid (blood) around his heart and coumadin levels were up to 7.6 which means that he had water for blood. The cardiologist was called into the hospital. When he look at everything, he called 2 surgeons to come in asap. A chest tube was inserted and they removed about a quart of fluid/blood mixture. The tube was left in for two more days and another pint to pint and a half drained. He then went into afib. He was in the CCU ward for4 days. After the chest tube was removed and medications stoped the afib, he was moved to the telemetry unit.
Of course the coumadin was discontinued to get the levels back down. He was started on coumadin 2 days ago, and his levels are only 1.7 which is too low to release him. At those levels, he needs to be monitored closely. They just started a heparin drip this afternoon. His blood will be tested every 8 hours to monitor him closely. Once he is stable, the cardiologist wants him to start by comming in for level tests 3 times a week. He will also have frequent echo's at least for a while to moniotrthe fluid arround the heart. If it decreases, then it is fine, but if it increases,we have a real problem. The the solution would be a permanent chest tube. Has anyone had similar problems with coumadin levles or complications like fluid compressing the heart and preventing it from functioning properly

 

[Nancy]

Hi Amy-

Your poor husband has really gone through a terrible experience. Do the doctors know what the cause of the fluid around the heart is? Is there something which can be fixed with surgery, like a leak. Or does he have Congestive Heart Failure or a pulmonary problem? You should know the exact diagnosis. Gee, a permanent chest tube?

I would press the issue about just what is causing the fluid buildup, and if need be, perhaps seek a second opinion.

I hope things turn around for him soon.

Coumdain levels are always fluctuating. Right now, my husband is on some antibiotics and his levels are changing. He's being tested twice a week. He was up to 7.1 at one point, but now is within range.

He has also had fluid in his lungs and other places as well, but he has CHF which is controlled with Lasix and low salt diet. He had to have a thoracentesis done at one point for fluid in his lungs, and that eventually led to lung surgery. Scar tissue had formed trapping his lung and causing partial collapse.

Take care

 

[Guest]

There must have been very few people look at the site yesterday for you to not get a reply to this. This is a fairly common complication after surgery it is called cardiac tamponade.

The high INR probably resulted from the heart pumping blood less effeciently. When this happens, the blood does not got hrough the liver as often as normal. That means that it does not get metabolized as well and the INR jumps.

In my experience, doctors who want to monitor warfarin levels every three days, do not understand how the drug works. They think that you give a dose and immediately see the results. In reality, it takes 2 or 3 days to see the full effect of a warfarin dose. So if they start changing the dose every three days, they will have him on a dosing roller coaster. It is very important that the past 7 days cumulative dose of warfarin be conmsidered when making changes.

Please look at my website www.warfarinfo.com