Hubby back in a-fib. *sigh*

[SatoriFound]

I know you guys must be sick of me by now.

I didn't drive to the hospital today because I had so many things I had to take care of at home. Hubby usually does these things, so it is my job while he gets well. I felt so guilty already, then I he texted he is back in a-fib. So, I went and pulled up the doctors notes. His most recent ekg states:

"Atrial fibrillation with rapid ventricular response-ST & T wave abnormality, consider inferior ischemia-Abnormal ECG-In automated comparison with ECG of 19-OCT-2024 18:44,-Atrial fibrillation has replaced Junctional rhythm-Vent. rate has increased BY 48
BPM-T wave inversion now evident in Inferior leads-T wave inversion now evident in Lateral leads"

Not being at the hospital I couldn't ask questions. Now I'm freaking out they damaged his heart and he may have ischemia as that is mentioned in the doctor's notes. So, once again they are want to do a Cardio Version. Hubby doesn't want to do what they say because he wants out of the hospital and he worries they will stop the Coumadin again so he is refusing drugs that can't be taken with it. He refused a medication due to that and the doctor came up with something he would agree to, but I feel like I'm on a roller coaster ride that I will never be able to get off of. This is day 11 in the hospital. I know it is the safest place for him, but now I feel like a real jerk for not being there.

He also has small-moderate circumferential pericardial effusion, mediastinal effusion, a periaortic hematoma and bi-lateral pleural effusion. The fluid just won't go away. He is walking and using the spirometer. He is on Lasik... Ugh. I just wanted this to be easy for him. And it seems like he is going to get every complication there is.

And then there is also the issue of flow turbulence in the left main coronary artery, which I googled. ARGHHHH Yet another thing. If he has to go back into surgery he will be beyond pissed off.

• Cause:
  The most common reason for turbulent flow in the left main coronary artery after AVR is the altered blood flow pattern around the prosthetic valve, which can create turbulence at the coronary ostium (the opening of the coronary artery) due to its positioning relative to the valve.
  
  
  
• Complications:
  Significant turbulence can lead to reduced blood flow to the heart muscle, potentially causing ischemia (lack of oxygen) and myocardial infarction (heart attack) in severe cases.
  
  
  
• Diagnosis:
  This condition is usually diagnosed using transthoracic or transesophageal echocardiography (TEE), which can visualize the blood flow patterns in the coronary arteries.
  
  
• Management options:
  
  
  • Monitoring: Close monitoring of the patient's cardiac function after AVR is crucial to detect any signs of coronary compromise.
    
    
    
  • Coronary angiography: Further evaluation with coronary angiography may be needed to assess the severity of the flow turbulence and identify any potential coronary artery stenosis.
    
    
    
  • Coronary artery bypass grafting (CABG): If the turbulence is severe and causing significant ischemia, a CABG procedure might be necessary to bypass the affected coronary artery.

 

[tjay]

I encountered some of these things right after my surgery as I outlined in my initial response on this thread:
https://www.valvereplacement.org/threads/12-week-update-work-in-process.889789/

- Your husband needs to work with them and follow their advice. They are your best friend and have best interest in mind. For example, if they need to stop coumadin to do certain procedures and/or to offer other drugs for a complication, he should follow along. I did. I trusted them with my care.
Taking a bit longer for INR to come to the range is the least of his concerns right now. It's the other things you are talking about which are much, much more important to deal with at the moment, as follows:

- Effusion around his heart and lung: Let them handle this as they want. For example, if they need to take him to catherterization lab to drain this effusion, or give Lasik, or whatever, and in the process adjust his other meds or coumadin, please do it.

- Turbulence thru Left main coronary: I'm not saying he has a bend in the left main coronary as I did, but it's interesting he's encountering something there as well. Did they not do CT on him (like they did to me even though I wasn't having any issues) to confirm if left main coronary (and others) are connected properly to his aorta? His ascending aorta was also replaced correct?
I don't know why all hospitals don't require a CT scan before discharge for aortic surgery, since I was lucky to have known about the kink/bend in my left main (as it was plugged back into the new aorta during surgery). Mine was probably not causing any turbulence or issue at the time but I benefitted from a CT scan my surgeon did proactively. Ask them if a CT scan would help in his case.

- AFib may be a result of Effusion or these issues he's dealing with. Resolving one may resolve others. If Afib may be going on for too long, cardioversion may be necessary IF they are suggesting it.

Just trust them. In this hour of need, you're already at the right place. Working with them will be helpful so that you don't take any issues home (and then come back later). I know it's really hard after so many days at the hospital but hang in there for a few more. Please provide some family/friends support there if possible.

Once again, hang in there. These issues are not uncommon and do get resolved. In 2-3 weeks, this will be a distant memory. Keep us posted and all the best.

 

[SatoriFound]

I encountered some of these things right after my surgery as I outlined in my initial response on this thread:
https://www.valvereplacement.org/threads/12-week-update-work-in-process.889789/

- Your husband needs to work with them and follow their advice. They are your best friend and have best interest in mind. For example, if they need to stop coumadin to do certain procedures and/or to offer other drugs for a complication, he should follow along. I did. I trusted them with my care.
Taking a bit longer for INR to come to the range is the least of his concerns right now. It's the other things you are talking about which are much, much more important to deal with at the moment, as follows:

- Effusion around his heart and lung: Let them handle this as they want. For example, if they need to take him to catherterization lab to drain this effusion, or give Lasik, or whatever, and in the process adjust his other meds or coumadin, please do it.

- Turbulence thru Left main coronary: I'm not saying he has a bend in the left main coronary as I did, but it's interesting he's encountering something there as well. Did they not do CT on him (like they did to me even though I wasn't having any issues) to confirm if left main coronary (and others) are connected properly to his aorta? His ascending aorta was also replaced correct?
I don't know why all hospitals don't require a CT scan before discharge for aortic surgery, since I was lucky to have known about the kink/bend in my left main (as it was plugged back into the new aorta during surgery). Mine was probably not causing any turbulence or issue at the time but I benefitted from a CT scan my surgeon did proactively. Ask them if a CT scan would help in his case.

- AFib may be a result of Effusion or these issues he's dealing with. Resolving one may resolve others. If Afib may be going on for too long, cardioversion may be necessary IF they are suggesting it.

Just trust them. In this hour of need, you're already at the right place. Working with them will be helpful so that you don't take any issues home (and then come back later). I know it's really hard after so many days at the hospital but hang in there for a few more. Please provide some family/friends support there if possible.

Once again, hang in there. These issues are not uncommon and do get resolved. In 2-3 weeks, this will be a distant memory. Keep us posted and all the best.

They have not done a CT, they have done three echos. According to those reports all the parts and pieces look "normal". What I read says the mechanical valve can cause turbulence, or that there could be a blockage due to plaque coming loose, or damage from surgical staples...

The thing about CardioVersion is it doesn't really fix the problem and it could come back if what is causing it isn't fixed. Ya know? If it is just normal healing and due to fluid/inflammation it seems that those issues should be fixed. I mean, he could get the CardioVersion, it stops the afib, and then an hour later the afib comes back.