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How to manage severe aortic regurgitation?

Q: I am 33 years old and married. I am taking treatment for rheumatic heart disease (RHD). Diagnosis is as follows: aortic regurgitation (AR) - severe; MR - Moderate; No hypertension; Heart disfunction 1+; RTI Problem -during weather changes; blood pressure - 145/80. Doctor says that there is no need for surgery and this can be controlled by regular medicine. I am taking the following medicines - Pentids 800 mg 0-0-1; Surbext cap 1-0-1; Lanoxion 0.25 mg weekly 5 days; Dioucontin K20-1-0-0. I have to restrict salt in my diet. Please advise.

A:Drug therapy of chronic AR is related to the severity of regurgitation, symptoms, LV function, and size. A mild AR with no change in cardiac size and moderate AR with slight limitation of cardiac reserve do not require any treatment except antibiotic prophylaxis for endocarditis. Echocardiography should be done annually with avoidance of vigorous athletic activity or isometric exercise. In MR, optimal treatment is aimed at increasing systemic cardiac output and decreasing regurgitant flow. No clear guidelines exist regarding when to initiate medical management; however, treatment probably is indicated when the LV begins to dilate. ACE inhibitors and diuretics are the mainstay of medical therapy for patients with MR. Inotropic agents are effective drugs when cardiac function is slightly decreased or compromised by the severity of MR. They increase the force of contraction of the myocardium and are used to treat acute and chronic CHF. Some agents also may increase or decrease the heart rate, provide vasodilatation, or improve myocardial relaxation. These additional properties influence the choice of drug for specific circumstances. The best person to evaluate and advise you would be your treating cardiologist.

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