Heart pumping EF
22%
Severe LV dysfunction
Echo: 02 Jun 2026
Prepared from uploaded reports through 02 Jun 2026
Health Master Summary for Mrs. Sandhya Rani
A family-friendly view of the big picture, current condition, historical trends, medicine patterns, risks to watch, and missing information needed to make the record complete. This page is optimized for phone viewing; use the top buttons to jump between sections.
Important limitation
This page is a structured summary of uploaded medical records. It is not a diagnosis or treatment plan. Do not change Acitrom, diuretics, diabetes medicines, thyroid medicines, or Cordarone based on this page alone. Dose decisions must come from her treating doctors.
Current condition: what we know up to 02 Jun 2026
These are the most recent clearly documented values from the uploaded records. Some areas are still incomplete because the surgery file and some current medicine details are missing.
INR
2.34
Slightly below printed range
PT/INR: 02 Jun 2026; printed range 2.5–3.5
Creatinine
2.03mg/dL
Kidney strain
RFT: 02 Jun 2026
Blood urea
116mg/dL
Very high
RFT: 02 Jun 2026
Pulmonary pressure
55mmHg
Moderate PAH noted
RVSP on echo: 02 Jun 2026
Tricuspid leak
Severe
Severe TR
Echo: 02 Jun 2026
Hemoglobin
9.8g/dL
Persistent anemia
CBC: 26 Apr 2026
Weight
72kg
Large drop vs 2025
Doctor note: 02 Jun 2026
Most important current picture
As of Jun 2026, the records show severe chronic heart failure with EF around 20–22%, prosthetic mitral valve with prior TV repair, severe TR, moderate pulmonary hypertension, unstable INR history on Acitrom, kidney dysfunction, diabetes, hypothyroidism, and persistent anemia.
Biggest missing file
The original MVR + TV repair surgery file is still needed to confirm valve type/model/date and the exact INR target.
Plain-language explanation for family
This section avoids medical jargon as much as possible. It explains what the records are showing and why doctors are monitoring these areas closely.
1. Heart pump is very weak
The EF number shows how strongly the heart pumps. Her EF was 38–42% in 2022, but is now around 20–22% in 2025–2026 records.
- This fits severe heart failure.
- It explains why swelling, breathlessness, cough, and fluid control are important.
- Latest EF: 22% on 02 Jun 2026.
2. Valve needs careful blood thinner control
She has a prosthetic mitral valve and a past “stuck valve” admission. Acitrom helps prevent clots, but the INR must stay in the doctor’s target range.
- INR too low: clot/stuck-valve risk.
- INR too high: bleeding risk.
- Latest INR: 2.34 on 02 Jun 2026.
3. Kidneys are under stress
Kidney numbers go up and down. This can happen with heart failure, fluid status, diuretics, diabetes, BP changes, or kidney disease.
- Latest creatinine: 2.03.
- Latest urea: 116, which is very high in the records.
- Kidney medicines/diuretics need doctor supervision.
4. Sugar control has been uneven
Diabetes control was poor in 2022, improved in Jan 2024, then became very poor again in Mar 2025.
- HbA1c 10.6% in Mar 2025.
- Newer HbA1c after Mar 2025 is not clearly available.
- Diabetes medicines must be checked with kidney function.
5. Blood level is low
Hemoglobin has been below normal for a long period. It was very low at 7.7 in Mar 2025, later around 9.8 in Apr 2026.
- This can cause tiredness, weakness, breathlessness.
- Cause is not proven from records.
- Hidden bleeding is important to rule out because she takes Acitrom.
6. Some information is still not confirmed
Some handwritten notes are unclear. The surgery file is missing. The exact current medication schedule must be verified from strips and doctor notes.
- Valve model/type: unknown.
- Exact INR target: not confirmed.
- Exact current Acitrom rotation: verify.
Visual trends with reference ranges
Charts make the patterns easier to see. Green shaded bands show common lab/reference ranges or, for INR, the printed therapeutic target. These ranges can vary by lab and doctor, so use them for comparison only.
Normal/reference range
Therapeutic target
Important threshold
EF trend: heart pumping strength
Lower EF means weaker pumping. The records show worsening from 2022 to 2025–2026.
Reference shown: normal adult EF is commonly about 55–70%. Values around 20–22% are far below this range.
INR trend: blood thinner control
The printed therapeutic range on many reports is 2.5–3.5. Exact target still needs surgery/cardiology confirmation.
Reference shown: teal band = report-printed therapeutic target 2.5–3.5. Grey band = usual non-anticoagulated INR 0.93–1.16; that grey band is not her goal while on Acitrom for a prosthetic valve.
Kidney trend: creatinine
Creatinine has fluctuated, with higher values around the Mar 2025 heart-failure admission and again Jun 2026.
Reference shown: Maruthi lab female reference is approximately 0.5–0.9 mg/dL; some older reports used 0.6–1.1 mg/dL.
Anemia trend: hemoglobin
Hemoglobin dropped from normal in 2022 to severe anemia in Mar 2025, then improved but stayed low.
Reference shown: common female hemoglobin range is about 12–15 g/dL. Values below this indicate anemia.
Diabetes trend: HbA1c
HbA1c improved in 2024 but worsened again in Mar 2025. Newer HbA1c after Mar 2025 is needed.
Reference shown: the uploaded lab categories list below 6% as normal, 6–7% as good control, 7–8% as moderate/fair control, and above 8% as poor control.
Urea trend
Urea was very high on 02 Jun 2026. This should be reviewed with doctors in the context of fluid, diuretics, kidneys, and heart failure.
Reference shown: recent Maruthi reports list the female blood urea reference as about 15–43 mg/dL; older/other labs may use different ranges such as 18–55 or 10–50 mg/dL.
Major timeline
A simplified timeline of the most important events. More detailed tables follow below.
May 2022
Hospital admission for “stuck mitral valve with TV repair”
Admitted 05 May–18 May 2022 with shortness of breath and lightheadedness. Treated medically; no surgery documented during this admission.
May–Jun 2022
Second admission for diarrhea/fainting
Admitted 30 May–06 Jun 2022 after repeated loose stools, fainting, and giddiness. Treated with antibiotics/antiemetics/supportive care.
2022–2023
Heart function gradually worsened
EF moved from 38–42% in 2022 to 35% in Feb 2023 and 30% in Sep 2023.
Mar 2025
Major deterioration and pulmonary edema admission
Admitted 04 Mar–12 Mar 2025 for acute pulmonary edema with shortness of breath and hand/leg swelling. EF around 20%; INR reached 5.22; kidney and diabetes numbers worsened.
Oct–Dec 2025
Severe heart disease persists; INR remains unstable
Echo in Oct 2025 showed EF 22%, severe TR, PAH. INR values included low 1.61 and high 4.54 in late 2025 records.
Feb–Jun 2026
Current severe LV dysfunction continues
Feb and Jun 2026 echoes show EF around 20–22%, severe TR, moderate PAH. Latest RFT on 02 Jun 2026: creatinine 2.03, urea 116, INR 2.34.
Detailed findings
These sections preserve the important details for doctor visits. Printed lab/echo reports are treated as higher reliability than handwritten notes.
High-confidence conditions documented or strongly supported
| Condition / issue | Evidence in records | Confidence |
|---|---|---|
| Status post mitral valve replacement | Multiple echo reports: prosthetic MV in situ / S/P MVR | High |
| Status post tricuspid valve repair | Multiple echo and discharge notes: TV repair | High |
| Prior stuck mitral valve event | 2022 discharge/consult notes: stuck mitral valve with TV repair | High |
| Severe LV systolic dysfunction / heart failure | EF 20–22% in 2025–2026 echoes; acute pulmonary edema admission | High |
| Severe tricuspid regurgitation | Severe TR in 2025–2026 echo reports | High |
| Pulmonary hypertension | RVSP 73 mmHg Mar 2025; RVSP 55 mmHg Feb/Jun 2026 | High |
| Atrial fibrillation / tachyarrhythmia | ECG/echo reports and notes; AF during echo | High, confirm ECG with cardiologist |
| Chronic anticoagulation with Acitrom | Repeated prescriptions and INR monitoring | High |
| Kidney dysfunction | Repeated high creatinine/urea | High |
| Diabetes mellitus | HbA1c/sugar reports and diabetes medications | High |
| Hypothyroidism | Thyronorm prescriptions and thyroid tests | High |
| Anemia | Multiple low hemoglobin reports | High |
| Recurrent cough/respiratory complaints | Many Vijaya Hospital outpatient notes | High for symptom pattern; cause unclear |
Echo / heart ultrasound trend
| Date | EF | Main findings |
|---|---|---|
| 05 May 2022 | 38% | S/P MVR; slightly increased gradient across MV; global LV hypokinesia; dilated LA/LV; moderate LV dysfunction; mild TR/PAH; no clot/vegetation. |
| 11 May 2022 | 42% | S/P MVR; acceptable gradient across MV; RWMA+; mild global LV hypokinesia; moderate LV dysfunction; trivial TR; no PAH; no clot/vegetation. |
| 29 Jun 2022 | 38% | Prosthetic MV in situ; acceptable gradient; concentric LVH; global LV hypokinesia; moderate LV dysfunction; mild TR/PAH; no clot/vegetation. |
| 17 Feb 2023 | 35% | Prosthetic MV in situ; acceptable gradient; concentric LVH; global LV hypokinesia; moderate-to-severe LV dysfunction; trivial TR; mild PAH; no clot/vegetation. |
| 21 Sep 2023 | 30% | S/P MVR + TV repair; acceptable MV gradient; dilated LV; concentric LVH; global LV hypokinesia; severe LV dysfunction; mild TR/PAH; no clot/vegetation. |
| 04 Mar 2025 | 20% | Prosthetic MV; S/P TV repair; grossly dilated LA/LV; severe LV dysfunction; mild TR; severe PAH, RVSP 73 mmHg; dilated non-collapsing IVC; AF during study. |
| 10 Apr 2025 | 26% | Lalitha echo: prosthetic MV; TV repair; LVD with dilated LA/LV/RA/RV; TR+++; PAP 72 mmHg; severe TR/PAH. |
| 18 Oct 2025 | 22% | Prosthetic MV; acceptable gradients; dilated LA/LV; severe LV dysfunction; severe TR; moderate PAH, RVSP 45 mmHg; mild RV dysfunction/TAPSE noted. |
| 09 Feb 2026 | 20% | Prosthetic valve in situ; TV repair; dilated LA/LV; severe LV dysfunction; severe TR; moderate PAH, RVSP 55 mmHg; AF during study; mild RV dysfunction/TAPSE 1.2 cm. |
| 02 Jun 2026 | 22% | Prosthetic MV in situ; acceptable MV gradient; dilated LA/LV; concentric LVH; severe LV dysfunction; severe TR; moderate PAH, RVSP 55 mmHg; IVC dilated/non-collapsing. |
INR / blood thinner trend
Exact target not confirmed
Many reports print therapeutic range 2.5–3.5. The exact target should be confirmed from her valve surgery/cardiology file.
| Date | INR | Record note |
|---|---|---|
| 06 May 2022 | 2.93 | During hospitalization. |
| 07 May 2022 | 2.46 | Slightly below 2.5 if target is 2.5–3.5. |
| 08 May 2022 | 3.17 | Therapeutic/high-normal if target 2.5–3.5. |
| 09 May 2022 | 2.11 | Low if target 2.5–3.5. |
| 10 May 2022 | 3.13 | Therapeutic/high-normal. |
| 24 May 2022 | ~1.92 | Handwritten; not fully clear. |
| 23 Jun 2022 | ~1.71 | Handwritten; not fully clear. |
| 29 Jun 2022 | ~5.09 | Handwritten; if correct, very high. |
| 17 Feb 2023 | ~3.24 | Handwritten; likely high-normal. |
| 21 Sep 2023 | 2.06 | Low if target 2.5–3.5. |
| 18 Jan 2024 | 3.72 | High. |
| 22 Jul 2024 | 3.89 | High. |
| 04 Mar 2025 | 5.22 | Very high; bleeding risk concern. |
| 08 Mar 2025 | 2.47 | Just below 2.5. |
| 09 Mar 2025 | 2.43 | Just below 2.5. |
| 10 Mar 2025 | 2.40 | Below 2.5. |
| 11 Mar 2025 | 2.63 | In printed therapeutic range. |
| 28 Mar 2025 | 3.34 | Therapeutic/high-normal. |
| 10 Apr 2025 | 2.27 | Below printed therapeutic range. |
| 04 Jul 2025 | 2.24 | Below printed therapeutic range. |
| 23 Sep 2025 | 1.61 | Low. |
| 06 Oct 2025 | 1.81 | Low. |
| 18 Oct 2025 | 3.80 | High. |
| 23 Dec 2025 | 4.54 | Very high. |
| 09 Feb 2026 | 3.71 | High. |
| 11 Mar 2026 | 2.62 | In printed therapeutic range. |
| 26 Apr 2026 | 2.57 | In printed therapeutic range. |
| 02 Jun 2026 | 2.34 | Slightly below printed therapeutic range. |
Kidney function and electrolytes
| Date | Creatinine | Urea | Sodium | Potassium | INR if same report | Notes |
|---|---|---|---|---|---|---|
| 05 May 2022 | 1.3 | 46 | 133 | 4.6 | — | Mild renal abnormality; glucose high. |
| 10 May 2022 | 1.7 | 65 | 134 | 5.0 | 3.13 | Kidney stress; K high-normal. |
| 21 Sep 2023 | 1.52 | 36 | 135 | 4.4 | — | Abnormal but relatively stable. |
| 18 Jan 2024 | 1.46 | 46 | 132 | 5.0 | 3.72 | Sodium low; INR high. |
| 04 Mar 2025 | 2.00 | 55 | 135 | 5.0 | 5.22 | Acute deterioration period; RBS 342. |
| 09 Mar 2025 | 2.30 | 70 | 137 | 4.8 | 2.43 | High creatinine during admission. |
| 28 Mar 2025 | 1.49 | 28 | 135 | 4.9 | 3.34 | Improved after hospitalization. |
| 10 Apr 2025 | 2.07 | 60 | 134 | 5.3 | 2.27 | Potassium high; kidney worsened again. |
| 18 Oct 2025 | 1.62 | 34 | 129 | 4.5 | 3.80 | Sodium significantly low; INR high. |
| 23 Dec 2025 | 1.95 | 71 | 143 | 4.6 | 4.54 | Kidney stress; INR very high. |
| 09 Feb 2026 | 1.70 | 92 | 143 | 4.6 | 3.71 | Urea high; INR high. |
| 26 Apr 2026 | 1.82 | 70.7 | — | — | 2.57 | Micro Labs report. |
| 02 Jun 2026 | 2.03 | 116 | 140 | 4.7 | 2.34 | Latest RFT; urea very high. |
Diabetes and thyroid
| Date | HbA1c | Related glucose | Notes |
|---|---|---|---|
| 05 May 2022 | 9.3% | RBS 301 | Poor control. |
| 06 May 2022 | 9.6% | RBS 364; FBS 309; PPBS 317 | Poor control. |
| 21 Sep 2023 | 8.8% | Mean glucose 206 | Poor control, better than 2022. |
| 18 Jan 2024 | 7.5% | Estimated glucose 169 | Improved. |
| 04 Mar 2025 | 10.6% | Estimated glucose 258; RBS 342 | Very poor control. |
| Date | T3 | T4 | TSH | Notes |
|---|---|---|---|---|
| 04 Mar 2025 | 0.50 | 16.00 | 5.15 | T3 low; T4 high; TSH near-high/high. |
| 09 Feb 2026 | 0.60 | 14.22 | 6.14 | T4 high; TSH high; T3 low-normal. |
Important thyroid note
TSH and T4 are both high in available reports. This is not a simple dose-change conclusion, especially because Cordarone/amiodarone can affect thyroid function. Endocrinology/doctor review is needed.
Anemia / blood count trend
| Date | Hemoglobin | Other CBC notes |
|---|---|---|
| 05 May 2022 | 13.3 | WBC 8400; platelets 2.77 lakh. |
| 17 Feb 2023 | 11.8 | WBC appears around 9.6; platelets 301k; neutrophil-heavy pattern. |
| 18 Jan 2024 | 9.9 | RBC 3.59; HCT 31.1; platelets 251k; WBC 7.57. |
| 04 Mar 2025 | 9.9 | RBC 3.53; HCT 31.3; platelets 237k; RDW high. |
| 15 Mar 2025 | 7.7 | RBC 2.79; PCV 24.3; platelets 2.60 lakh; neutrophils 86%. |
| 18 Oct 2025 | 9.5 | RBC 3.25; HCT 28.8; WBC 9.15; neutrophils 82%. |
| 26 Apr 2026 | 9.8 | RBC 3.69; PCV 31.1; platelets 2.24 lakh; WBC 5.4. |
Outpatient cough/respiratory/vitals pattern
Many Vijaya Hospital notes from 2025–2026 appear to be for cough, post-nasal drip, URTI/rhinitis-type symptoms, or respiratory complaints. Exact handwritten medicine names are often unclear and are not treated as definitive.
Oxygen
SpO2 was often preserved around 97–99% in outpatient notes.
Pulse
Pulse was frequently high, with readings around 110–124/min on several visits.
Weight
Weight was around 80–82 kg in many 2025 notes, but 72 kg was documented on 02 Jun 2026.
Medication pattern from records
This is not a verified current prescription. It is a careful extraction of medicines repeatedly seen in discharge summaries and prescriptions. Exact current dose/timing must be checked against the latest doctor prescription and medicine strips.
Do not use this as a dosing chart
Acitrom, Dytor Plus, Zytanix, Thyronorm, Cordarone, and diabetes medicines can be dangerous if changed without medical supervision.
| Medicine seen | Category / likely purpose | How it appears | Reliability |
|---|---|---|---|
| Acitrom | Anticoagulant / blood thinner | Repeatedly prescribed; dose schedules vary, including alternating/rotating doses. | Name high; current dose verify |
| Ecospirin AV 75/20 | Antiplatelet + statin combination | Repeatedly prescribed, often once daily at night. | High |
| Cordarone 100 mg | Rhythm control / antiarrhythmic | Repeatedly prescribed, often OD. | High |
| PAH 20 mg | Pulmonary hypertension medicine | Repeatedly prescribed BD in 2025–2026 notes; generic not confirmed. | Medium-high |
| Dytor Plus | Diuretic / fluid control | Repeated; dose appears differently across notes. Current exact dose unclear. | Verify dose |
| Zytanix 5 mg | Diuretic / fluid control | Repeated, usually OD around 2 pm. | High |
| Ozomet / Ozomet VG2 / Vogomet VG2 | Diabetes | Repeatedly listed, often BD; exact formulation needs verification. | Medium-high |
| Istamet 50/500 | Diabetes | Repeatedly listed, often OD around 2 pm. | High |
| Empaglyn 10 mg | Diabetes / heart-kidney medicine category | Appears in 2026 medication notes, OD. | Medium-high |
| Thyronorm 150 / 175 mcg | Thyroid replacement | 150 mcg in older notes; 175 mcg appears in 2026 notes. Verify current dose. | Verify current dose |
| Pantop 40 mg | Stomach protection | Repeated, often OD morning. | High |
| Supradyn / Ichel / Aristozyme / Cremaffin | Supplements/supportive/GI medicines | Seen in several lists; current use varies. | Verify |
What we still need to make this more complete
These missing items will make future summaries more precise and safer to use in doctor conversations.
Highest priority missing file
- Original MVR + TV repair surgery file.
Needed to confirm surgery date, valve type, brand/model/size, operative details, and exact INR target.
Current medicine verification
- Photos of every current medicine strip, front and back.
- Latest handwritten prescription photographed clearly, full page, no blur.
- Doctor-confirmed Acitrom rotation schedule.
Current tests to update
- Latest HbA1c after Mar 2025.
- Latest CBC after Apr 2026, if done.
- Latest RFT/electrolytes after 02 Jun 2026, if done.
- Latest ECG after Jun 2026, if done.
Doctor plan documents
- Written cardiology plan for fluid restriction and diuretic adjustment.
- Nephrology review, if any.
- Any report explaining anemia cause or Hb 7.7 in Mar 2025.
Unclear items intentionally not guessed
Exact valve type, exact INR target, exact Acitrom rotation, exact Dytor Plus dose, exact diabetes/insulin regimen, cause of cough, cause of anemia, and exact cause of kidney dysfunction remain unconfirmed unless a printed report or clear doctor note confirms them.
Questions to ask doctors
Take these to appointments. They are written to get clear answers and avoid guesswork.
Cardiologist / cardiac surgeon
- What exact valve type does she have: mechanical or bioprosthetic?
- What is her exact target INR range?
- Given prior “stuck mitral valve,” does she need any special anticoagulation protocol?
- What is the plan for EF around 20–22%?
- Is her current pulse/rhythm adequately controlled?
- Is Cordarone still appropriate with QTc around 480–502 ms and thyroid abnormalities?
- What is the plan for severe TR and PAH?
- What fluid and salt limits should the family follow?
Nephrologist / physician
- Does she have CKD, cardiorenal syndrome, or both?
- How should diuretics be adjusted when urea/creatinine rise?
- Is urea 116 mg/dL on 02 Jun 2026 concerning enough for urgent recheck?
- Which diabetes medicines are safe at her current kidney function?
- What potassium/sodium levels should trigger urgent review?
Diabetologist / physician
- What is her latest HbA1c after Mar 2025?
- What glucose targets are appropriate with severe heart failure and kidney dysfunction?
- Should she use insulin? If yes, what exact schedule?
- How often should home glucose be checked?
Thyroid / anemia questions
- Why are TSH and T4 both high?
- Is Thyronorm 175 mcg correct, or should the dose be reassessed?
- Could Cordarone be affecting thyroid results?
- What is causing the anemia?
- Should iron studies, ferritin, B12, folate, stool occult blood, or reticulocyte count be checked?
Emergency warning signs for family
Given her documented heart failure, valve history, kidney dysfunction, anemia, and blood thinner use, these symptoms should be taken seriously.
Seek urgent/emergency care if any of these happen
- Severe or worsening breathlessness.
- Breathlessness while lying flat or waking up gasping.
- Chest pain, fainting, confusion, or new weakness.
- Very fast or very irregular pulse with symptoms.
- Sudden swelling of legs/hands/abdomen or rapid weight gain.
- Very low urine output.
- Black stools, blood in stool/urine, vomiting blood, or heavy bleeding.
- Large unexplained bruises.
- Fever with worsening breathing or weakness.
- Repeated vomiting/diarrhea, because it can destabilize kidney function, electrolytes, and INR.
Short version for a new doctor
A compact paragraph that can be copied into a message or shown at consultation.
Mrs. Sandhya Rani is a female from Repalle with history of mitral valve replacement and tricuspid valve repair, complicated by a documented stuck mitral valve admission in May 2022. She is on chronic anticoagulation with Acitrom, with highly unstable INR values ranging approximately 1.61–5.22. She has progressive severe LV dysfunction: EF 38–42% in 2022, 35% in 2023, 30% in Sep 2023, and 20–22% in 2025–2026. She was hospitalized in Mar 2025 for acute pulmonary edema. Latest echo on 02 Jun 2026 shows EF 22%, prosthetic MV with acceptable gradient, severe LV dysfunction, severe TR, moderate PAH with RVSP 55 mmHg, and dilated non-collapsing IVC. She also has diabetes, hypothyroidism, chronic kidney dysfunction, persistent anemia, and recurrent cough/respiratory outpatient visits. Latest RFT on 02 Jun 2026 shows creatinine 2.03, urea 116, sodium 140, potassium 4.7, INR 2.34. Most recent clearly documented Hb was 9.8 on 26 Apr 2026. The surgery file is pending and is important to confirm valve type and INR target.