Brian's Journal

Jim Moody  Entresto seemed to help my wife. her EF is 55% now and she has shortness of breath for other reasons but she doesn't feel exhausted.  

Marie Myers  Have not experienced this myself, but the cardiologist may change your meds to help improve the ejection fraction and hypokinesis. Are you experiencing symptoms like fatigue and shortness of breath?

Klara Čičić  Dear Brian hypokinesis and akinesis mean weakening of part of heart muscle usually as a result of ischemia or low blood flow from coronary arteries to the heart muscle, which then becomes hypokinetic (it moves differently from the rest of the heart).  You might had a silent smaller heart attack/s without even realising, especially if you are diabetic this might be the case. Ask your cardiologist or primary care physician for full explanation as they know your full history and records... With medications and good heart care (healthy lifestyle) one can live with this condition. Good luck and take care! 

Brian Leonard  Thanks ladies - they are saying I have a left bundle branch block - and I have known that since my aortic valve was replaced - they are giving me some meds to try and increase the ejection fraction  - I am not experiencing any fatigue or swelling and have always felt great before my surgery and after - I have never had any symptoms - that is why I am always worried to get an echo because they always say "how are you doing" and I am like - I guess I have no idea - you tell me!! then the numbers come back and rarely are they good - but my ejection fraction has been this low before and somehow improved and now its back down - I wonder how accurate these tests are and how much interpretation is involved ?? UGH!!

Rita Savelis  Your doctors will definitely take into consideration your anticoagulants and direct you. You will either bridge with shots or with an IV of heparin. Again, they will let you know when to stop your pills, when to start shots, when to take pills again. You will remain on both until your INR is back in your target range. Again, know that they will direct you and prep will usually begin a few days before your procedure. Any advice will come from your doctors and/or your anesthesiologist. 

Brian Leonard  Rita thanks- I am worried about a bleeding event or blood clots - just seems like what would have been a fairly straight forward surgery is suddenly much more complicated  - I di not really consider this when I selected the mechanical valve but still dont think I would have wanted to go tissue as I just dont want to redo the valve and I think I have a better chance of not redoing it with mechanical - although I have seen some people on this site that are indeed redoing mechanical valves - ugh..............

Rita Savelis  Hi Brian. I have had many simple and less simple surgeries since my 2 mechanical valves were placed 8 years ago. Anyone on anticoagulants (for any reason) needs to follow certain procedures, even for very simple interventions like a biopsy or a colonoscopy. If it's your aortic valve that is the mechanical that is a much simpler valve to deal with than your mitral valve where it is really not advisable to stop anticoagulants. At first I was so annoyed that I had to go through these bridging procedures (with shots or IV). I didn't worry about bleeding events or clots as I always felt that doctors have this under control during surgery. It was just annoying to deal with. Now it's just a part of my life. Again, sorry that you have to deal with it. Heavy sigh.

Marie Myers  Most likely you will be bridged over to heparin for your surgery, and then resume Coumadin a day or so after surgery. This must be carefully coordinated with your  surgeon ,anesthesiologist, and cardiologist . 

Rita Savelis  Whoever is doing your surgery (and is informed that you are on an anticoagulant) will make sure that you bridge, which means you will stop your coumadin a few days before surgery and replace it with shots of lovenox (or intravenous heparin if you are in hospital). Then after your surgery you will start coumadin again but continue the shots until you reach your target INR. I have done this many many times as I have had surgery 5 or 6 times since my double valve replacements. Any doctor, surgeon, anesthesiologist, cardiologist can give you instructions and a prescription for lovenox shots.

Richard Munson  There is a procedure called bridging i contemplated using after stopping eliquis before surgery. Not sure about it other than what i have read.

Marie Myers  Yes, Richard is correct. The doctors “bridge” the patient from warfarin to heparin before surgery and through recovery. So after surgery, the patient will be returned to warfarin .Heparin levels are more easily controlled than warfarin, but it is given either intravenously or as a subcutaneous (under the skin) injection.

Brian Leonard  so is the warfarin stopped before surgery - like 5 days prior? or you just take as normal up to the surgery? sounds like the heavy bleeding would still be an issue

Marie Myers  Yes, warfarin is stopped 5-7 days prior to surgery, and the heparin is started 3 days prior. Some surgeries like cataract surgery don’t require stopping anticoagulants. Lots of things depend on the type of surgery also. Your cardiologist and surgeon will work together to manage your medications. 

DeLois Tweedy  Brian, I had aortic valve replacement with tissue valve and am on Eliquis. I have had 2 surgeries since and cardiologist stopped Eliquis 2 days (48 hrs) before and 2 days after surgery. I was anxious abt it, but had no problems. Warfarin may be different. I would definately check with my cardiologist.