Q: My 38-year-old wife is suffering from RHD with mitral valve stenosis. She underwent BMV 12 years back with mitral valve area (pre-BMV 1.3 sq cm and post BMV=1.7 sq cm). She is also having bronchial asthma. Now the 2D Echo shows that there is mitral restenosis and the doctor has prescribed her Met XL 12.5 mg (metoprolol succinate); Dytide (benzthiazide and triamterene) and Digoxin 0.25 mg for her heart and Unicontin 400 mg for her asthma. Recently, I showed the papers to an eminent visiting cardiologist who has prescribed Dilzem (diltiazem HCl 30 mg) in place of Met XL and Amifru (amiloride and frusemide) in lieu of Ditide. He has also replaced Unicontin 400 mg with Deriphylline 150 mg. Please let me know which prescription she should follow.

A:Mitral restenosis needs re-ballooning or surgery. Diltiazem is a better alternative if she has asthma. However, if the asthma developed after re-stenosis, you know it is secondary to the heart problem and a combination of low dose metoprolol (like the 12.5 XL) with diltiazem is a good combination to control the increase in heart rate with exercise or mental tension that may precipitate lung congestion. Amifru is a more powerful urine pill than the one you were prescribed earlier and you can choose this. Deriphylline and Unicontin are essentially the same, but as they can increase the heart rate and predispose to arrhythmias, it's wiser to use Asthalin or Seretide inhaler (with spacer) as this delivers the drug directly into the lung rather than into the whole blood stream. These changes are to be made by a cardiologist or physician experienced with heart problems. If the heart is beating irregularly, she will need blood thinners to prevent brain stroke.