16/Male boy with severe Dyspnoea on and off , Giddiness and Tiredness attached the ECHO What is the Treatment Plan Mitral Regurgitation : Severe Aortic Regurgitation: Moderate

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Pt needs both mv &Av replacement till then treat with Anti ccf tt_ lasilactone,srd, envas/ digoxin 2.5 mg od for 5/7days,prophylaxis for bacterial endocarditis

Ecg Chest leads recorded at 5mm/mv LVH Echo suggest VALULAR problem

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Valves repair, inj Benzathine penicillin, diuretic, anticogulent, MV , +An homeo Drug "Card aid gold drops" will help for dyspnea

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Pt needs both valve Repair/ Replacement , owing to NYHA class 3. Long term penicillin prophylaxis, diuretics, ACE inhibitor/blocker. Pt. will need life long aspirin/ clopidogril therapy if valve repair only and anticoagulation if both valves replaced. Pt. May need anticoagulation with INR of 2.5 to 3.5 before surgery if Pt is in AF.

Almost all doctors replying have asked for anticoagulation. Is there any recommendation for anticoagualation in a patient with valvular heart disease but who is in sinus rhythm.

Pt in sinus rhythm does not need anticoagulation unless there is some other indication. However present guidelines recommend anticoagulation with warfarin or coumarins ( not recent oral anticoagulants i.e Dabigartran etc) if pt is having chronic AF or intermittent/ recurrent AF. However all Pts. need anti coagulation after valve replacement if mechanical valve/s is/ are used.
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Mitral valve repair Diuretics Anticoagulants

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MVR and aortic valve replacement along with anticoagulant, diuretics, prophylaxis for infective endocarditis

I think pt needs to be managed on decongestive therpy , ace(i), rheaumatic fever and BE prophylaxis and anti coagulants be given only if AF or huge LA with spontaneous contrast or documented clot in LA/LAA. All this only if pt is not severly symptomatic ie is not in class 3 or class 4. Surgery be deferred till the age of at least 18 lest he should need another MVR and AVR

Valves repairs treatment of CHFand prophylaxis for BE

Double valve replacement. Oral anticoagulation and penidure prophylaxis

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