Stevens Health - Medication and Toe Test

When Steven was a baby he was always getting chesty colds and breathless during the winter months, and on a visit to the surgery, his heart wasn't making the right noise.
Then when he was 18mths he was diagnosed with a narrow mitral valve which restricted blood flow to the heart, Medical term Mitral Stenosis.
He was placed under Doctor Taylor of Great Ormond Street who monitored it.
In 1984 he was taken into Great Ormond Street for a repair, this failed and 4 weeks later when we attended an outpatient appointment he was kept in and he had the valve replaced.
The first time i saw him after the operation was awful, he was covered in dried blood and unconscious, he hadn't been cleaned up, he remained in intensive care for several days.
2 open heart surgeries in 4 weeks.
Steven also had 2 catheters, which is where they put a tube in his hip and spray dye into his heart muscle to take pictures of the heart, it is an all day procedure including recovery, and takes a few days to recover properly, the first time was before he had an operatiion, the second time was scheduled between operations, on his 7th Birthday, but i persuaded them to do it the next day, within a few days of this he had a second operation.
During Stevens second time in hospital, the Queen Mother was scheduled to visit the Outpatients, and someone left a package in the waiting room, so all of the ground floor was evacuated.
While in hospital Steven made friends with a boy called David and we went and stayed with them for the weekend, when we got home.   He also attended a Hospital Cub Scout Pack.
During Stevens stay in hospital we stayed in a house round the corner called Rainbow House, it was run by a charity for parents of patients at Great Ormond Street, it had not long opened and we were interviewed by The Nursing Times about the facilities it offers.
He took digoxin, to strengthen his heart beat for a few months, and was placed on Warfarin an anti coagulant for life, which meant he had to have regular blood tests, to check his blood clotting.
In 2009, Steven got a leaky heart valve and blood clot on another valve and was admitted to Queen Elizabeth Hospital in Kings Lynn, they decided to leave his leaky heart valve at least for the time being, they treated his blood clot with Clot Busting Drugs, this was successful, he was in hospital about 3 weeks, because they had to monitor his INR (Blood Clot), till they were happy with it.
To diagnose the problem properly Steven had to have a TOE

What is a transoesophaegal echo (TOE)?

A transoesophaegal echo (TOE) is a special type of heart ultrasound that involves taking pictures inside your oesophagus, which is the tube connecting your mouth to your stomach. As your oesophagus is close to the back of your heart this allows your doctor to see clear pictures of your heart.

What is a TOE Test?

Your aneasthetist will supervise your sedation during your TOE test. If you have had previous problems with an anaesthetic, or you have any severe allergies please inform the doctor as soon as possible.
During the test a small needle is inserted into the back of your hand so that intravenous medicine can be given to make you sleepy. Your throat will be sprayed with local anaesthetic to make it easier to swallow. A special mouthpiece will be put in your mouth to protect your teeth. The echo probe will be gently inserted into your oesophagus and pictures will be taken of your heart. The test will take between 15 to 30 minutes to complete.
Your pulse, blood pressure, rate and regularity of your heart beat and oxygen levels will be monitored during the test. If you doctor has any concerns, the test may be stopped. At the end of your test the probe will be removed.

Steven then had a Clot Busting Drug Claxane

Clexane injection contains the active ingredient enoxaparin, which is a type of medicine called a low molecular weight heparin. It is used to stop blood clots forming within the blood vessels.
Blood clots normally only form to stop bleeding that has occurred as a result of injury to the tissues. The clotting process is complicated and begins when blood cells called platelets clump together and produce chemicals that activate the clotting process. The final part of this process involves a substance called thrombin being activated to produce a protein called fibrin. Fibrin binds the platelets together, forming a blood clot. This is the body’s natural way of repairing itself.
Sometimes, however, a blood clot can form abnormally within the blood vessels. This is known as a thrombus. It can be dangerous because the clot may detach and travel in the bloodstream, where it becomes known as an embolus. The embolus may eventually get lodged in a blood vessel, thereby blocking the blood supply to a vital organ such as the heart, brain or lungs. This is known as a thromboembolism.

Steven was then put on Perindopril

About perindopril

Type of medicine	ACE (angiotensin converting enzyme) inhibitor
Used for	Hypertension (high blood pressure) Heart failure (where the heart is unable to pump blood efficiently) To help prevent problems after heart attacks and procedures to help increase blood flow through the heart
Also called	Perindopril arginine, perindopril erbumine, perindopril tert-butylamine Coversyl Arginine®
Available as	Tablets

Perindopril works by causing blood vessels to relax, lowering blood pressure and increasing the supply of blood and oxygen to the heart.

Steven is on Furosemide, to aid the treatment of his leaky valve.

Furosemide

<big>About Furosemide</big>
This belongs to the group of medicines known as Loop diuretics. Diuretics are often referred to as water tablets.
Furosemide is used to treat oedema (water retention) due to heart failure.

If the heart becomes less efficient at pumping blood around the body, fluid leaks out of the blood vessels causing swelling in the tissues of the lungs, feet or ankles. Furosemide prevents the build up of fluid by increasing the amount of urine produced by the kidneys.

INR

The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. They are used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status. The reference range for prothrombin time is usually around 12–15 seconds; the normal range for the INR is 0.8–1.2. PT measures factors I, II, V, VII, and X. It is used in conjunction with the activated partial thromboplastin time (aPTT) which measures the intrinsic pathway.

International normalized ratio

The result (in seconds) for a prothrombin time performed on a normal individual will vary depending on what type of analytical system it is performed. This is due to the differences between different batches of manufacturer's tissue factor used in the reagent to perform the test. The INR was devised to standardize the results.
Each manufacturer assigns an ISI value (International Sensitivity Index) for any tissue factor they manufacture. The ISI value indicates how a particular batch of tissue factor compares to an internationally standardized sample. The ISI is usually between 1.0 and 2.0.
The INR is the ratio of a patient's prothrombin time to a normal (control) sample, raised to the power of the ISI value for the analytical system used.
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Leaky Heartvalve that Steven has is as below

Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle.^[1]
Aortic insufficiency can be due to abnormalities of either the aortic valve or the aortic root (the beginning of the aorta).