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Had Mechanical Valve Replacement. Has Seizures. Taking Dilantin. Cause?

Posted on Mon, 10 Jun 2013

Question: Hi Doctor-
My mother is in the hospital after we found her non-responsive, small amount of blood at the corner of her mouth, and heart beat around 35. She had emergency surgery Tuesday (5/14) to implant a pace maker and her heart seems ok now. She had a mechanical valve replacement 27 years ago and has been on Coumadin ever since. Her INR was 4.7 (dnagerously high for her) today because the Dr.'s mistakenly had her on coumadin and agratoban at the same time. She also, has seizures and is on Dilantin and hemoglobin is now low even after she's been given blood and she is also having a hard time breathing. Can you help us try to figure out whats causing this? Thank you.

Answered by Dr. Sushil Kumar Sompur (11 hours later)

Hi there ~

I understand your concern for your mother. I believe that she has been having a lot of issues for a long time. I am glad you list them in her medical history. I am sure she has been on medications for these issues i.e. mechanical heart valve replacement (blood thinners and dilantin), seizures (AEDs), hypertension (antihypertensives), cerebral hemorrhage (coumadin), hepatitis C (lamivudine or other liver pills I am guessing). Her current condition is concerning to say the least and it seems like she is in a coma with being found non-responsive. I believe that you should listen to her doctors as they know best what her condition is like and what could be causing this. Having a conference with the team of doctors that are taking care of her and having them tell you your mother's prognosis would be helpful. I think it will be very helpful to do so. I also believe that you should get all her affairs in order, not to be pessimistic but I do believe that her condition is slowly but surely deteriorating.

I am sure you have had great moments with your mother, and I hope you continue to do so as long as she is able. I wish you and your family all the very best.

Take care and have a lovely day!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sushil Kumar Sompur (13 minutes later)

Thanks for your reply and advice. Unfortunately, I
Was looking for medical advice. My mother was a very
active 89 year old woman...she was able to take care of herself.
Clearly, there's something happening that is being missed by the doctors.
She was only taking Coumadin, Dilantin and blood pressure medication.
Her liver was fine no meds were needed.

Thanks, XXXXXXX

Answered by Dr. Sushil Kumar Sompur (3 minutes later)

Hi there ~

I understand your concerns and I am also hopeful that she can get back to her active self again. I do not think that there is anything missing except for giving her coumadin and agratoban for her condition. I hope this was addressed. I wonder if a CT scan or another imaging study was done to find out if there was XXXXXXX hemorrhage. This is usually the case when the blood vessels are very fragile and blood is thinned out the way it was in her case.

I hope this helps. Take care!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sushil Kumar Sompur (3 minutes later)

Hi- she is no longer in a coma. Yes, Ct's scan have
Been done and X-rays no sign of hemorrhaging.

Answered by Dr. Sushil Kumar Sompur (10 minutes later)

I am glad to hear that she is not in a coma anymore. I believe that she may have had a breakthrough seizure.

Take care cristina!

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar