What could cause chest pain and blurred vision after MVR?

Question

Hello doctor,

My father had PTMC twice. He had also undergone an MVR for 10 years. Unfortunately, his heart rate always seems to rise to 150 or 160. Two years back, he had a cardioversion and was fine with the drugs Renozex and Sotalex.

After the MVR, he was on Warfarin and his INR was fine. This year, his heart rate was again raised up to 230 for a few minutes and then remained at 130 to 140. Yesterday, he was discharged with a heart rate of 110. The current medications include Sotalex 80 twice a day, Renozex 500 twice a day, Flecainide 150 twice a day, and Ivabradine 5 twice a day.

But, since yesterday, he has had a little chest pain and blurred vision. Kindly advice.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have noted all your details.

The Holter reports (attachment removed to protect patient identity) of your father reveal his baseline rhythm to be atrial fibrillation. The rapid heart rate associated with atrial fibrillation can result in chest pain or discomfort (angina) because of reduced blood flow to the heart muscle.

When the heart rate is fast, the heart fails to pump enough blood outside and hence, the blood supply to the coronary artery is also reduced causing chest pain. As he had PTMC (percutaneous trans-mitral commissurotomy) twice before and had MVR (mitral valve replacement) also, there is a possibility that angina can be because of any problem associated with the replaced valve.

As your father has multiple issues, a valid comment about the cause of angina can be given only after a thorough analysis of his old and latest echo and ECG reports. Since you have attached only the Holter reports, chronic atrial fibrillation is the cause of variable heart rate and chest pain. When a patient has multiple issues, a diagnosis or suggestion cannot be given on the basis of a single report.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.