Q: I am 41 years old. Fourteen years back I had an open heart surgery and one mitral valve was inserted. I take acetrom regularly under the guidance of my doctor who operated me. Ten years later I had some problem of heavy headache which led to sub-dural heamatoma and it was operated again. After an occasional attack of black out I had a massive black out followed by breathlessness and as a result I went senseless for three hours, where I remained unattended for quite some time. At the last moment I was shifted to a government hospital where I regained consciousness after an oxygen cylinder was provided. Later I was shifted to a better nursing home and was under treatment in the ICU. There the doctors increased the dosage of acetrom and I became fine. I took tests - ECG, Brain CT Scan, Echo and TEE (Transoesophageal Echocardiography) and everything turned out to be fine. Recently I was discharged after being declared normal. If all these reports are normal then what went wrong? What should be the future course of treatment?

A:Loss of consciousness could be because of a number of reasons. However two major problems with valves are: 1) Either you have clots on the valve which have dislodged and got settled in the brain leading to loss of consciousness. 2) The levels of anti-coagulation are very high, one can get blood in the brain producing the same end result of stroke or loss of consciousness. You had an attack of black out and headache and sub dural heamatoma which was operated. This was a complication related to anti-coagulation. However, there are many other causes of loss of consciousness besides the two mentioned above which may not be entirely related to heart but to other organs of the body or the blood vessels supplying the brain. I suggest for this kind of complex problem, you should consult a neurologist or a cardiologist who will be able to help you better.