New Cardio Question

[palmaceae]

Hello all,
I just saw a new Cardiologist a few weeks ago (they all belong to a group and this one now is in our area) and he is the type of doctor who does not like to prescribe medication, and he does not believe in yearly echos. So he wanted to take me off my calcium beta blocker pills and my cholesterol pills. He also thinks I do not need a yearly echo, so my question is, is this normal, should I look for another cardio?
I certainly like the idea of not taking meds but not sure of the validity of such a step. My cholesterol has always been high which has been controlled by meds and diet, so to stop taking them seems a bit drastic. The other concern is taking me off the calcium beta blocker, I have been taking them since my AVR in March 2009. I do have issues with PVC's but them do not seem too concerned about them.
My real concern is not having a yearly echo, I thought that was pretty important, this is the first cardio that said it was not necessary. He thought by listening to my heart would give any indication of any issues. Again this is a good way to save money but still a bit concerned about stopping what I have been doing.
Any thoughts on this?
Thanks,

 

[dfelder]

I would run and fast. You really need a yearly echo.

 

[Lynlw]

Its pretty common after the first few years post op to move to echos every other year as long as things sound good and no symptons.

 

[escargome]

I don't know, I also have high cholesterol and diabetes. Both my cardio and internist work together. My cardio wants to see me every 6 months and my internist every 3. So maybe you should check out a different doctor.

 

[Mentu]

I guess the 3000TFX was popular in 2009; mine is the same. My cardio has told me that he would still like an echo cardiogram each year since I have a tissue valve. On the other hand, my initial diagnosis was made by my family doctor using her stethescope. With respect to the change in medications, however, mine are all prescribed by my family doctor - even the one remaining medication that my cardio suggested. Discussing this with your own family doctor would at very least be a good idea and it would, in effect, give you a second opinion. If you are still concerned, you can always seek the opinion of a cardiologist outside of your doctors practice.

Larry
Tulsa, OK

 

[Jkm7]

I think it a good idea to discuss this with your PCP. It would make me very uncomfortable to not have annual Echo.
If your instinct tells you this is not the right cardio for you, listen to your inner voice. Our instincts are usually right.

 

[neil]

agree with jkm if in doubt get a 2nd opinion

 

[Duffey]

There are probably guidelines somewhere that address the frequency issue, but I don't know where they are.

I have the same valve minus the TFX process, and I'm seen every year and have an echo run as part of the exam. Do you think it has something to do with insurance or do you think it's the cardio's own little peculiarity?

If you're uncomfortable, and I can see why you would be, I'd look for a different cardiologist but make sure he/she will respect your wishes before you switch.

 

[ElectLive]

At the very least, I would insist on a better explanation of the medical evidence for all of those issues. I won't hazard a guess on what's appropriate for your particular situation, but for reference on just echo frequency, here is an excerpt from the ACC Valve Disease Guidelines:

"B. Follow-Up Visits

Class I
1. For patients with prosthetic heart valves, a history, physical examination, and appropriate tests should be performed at the first postoperative outpatient evaluation, 2 to 4 weeks after hospital discharge. This should include a transthoracic Doppler echocardiogram if a baseline echocardiogram was not obtained before hospital discharge. (Level of Evidence: C)

2. For patients with prosthetic heart valves, routine follow-up visits should be conducted annually, with earlier re-evaluations (with echocardiography) if there is a change in clinical status. (Level of Evidence: C)

Class IIb
Patients with bioprosthetic valves may be considered for annual echocardiograms after the first 5 years in the absence of a change in clinical status. (Level of Evidence: C)

Class III
Routine annual echocardiograms are not indicated in the absence of a change in clinical status in patients with mechanical heart valves or during the first 5 years after valve replacement with a bioprosthetic valve. (Level of Evidence: C)

...

2. Follow-Up Visits in Patients Without Complications
Patients who have undergone valve replacement are not cured but still have serious heart disease. The clinical courseof patients with prosthetic heart valves is influenced by several factors (550), including LV dysfunction, progression of other valve disease, pulmonary hypertension, other cardiac diseases, complications of prosthetic heart valves, and clinical heart failure. The interval between routine follow-up visits depends on the patient’s needs. The asymptomatic uncomplicated patient needs to be seen only at 1-year intervals, at which time a complete history and thorough physical examination should be performed. No further echocardiographic testing is required after the initial postoperative evaluation in patients with mechanical valves who are stable and who have no symptoms or clinical evidence of LV dysfunction, prosthetic valve dysfunction, or dysfunction of other heart valves (1). Once regurgitation is detected, close follow-up with 2D and Doppler echocardiography every 3 to 6 months is indicated. Echocardiography is indicated in any patient with a prosthetic heart valve whenever there is evidence of a new murmur or change in clinical status, when there are questions about prosthetic valve integrity and function, and when there are concerns about ventricular function."