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It was highly instructive for me to read this recent detailed article. If I may be permitted to add some comments, I am familiar with the case of a 71 year old fit female with no previous cardiac history who was admitted to hospital in late 2016 with a community-acquired pneumonia. Quite apart from the pneumonia, she was found to be in atrial fibrillation, was cardioverted and placed on Rivaroxaban along with other treatments for the pneumonia and cardiac arrhythmia. Her echocardiogram at the time showed an LVEF of 45%.
In subsequent follow-up with an internist, she was told that she had heart failure and that it had pre-dated the pneumonia. No evidence for this was offered. She was recommended to continue the Rivaroxaban, along with Digoxin, Ramipril and Metoprolol.
Negotiations with the internist were prolonged, but over the course of several months she persuaded him with some difficulty to discontinue the Digoxin, Ramipril and Metoprolol, while the Rivaroxaban was maintained, as it has been to this day. Several echocardiograms followed, both on and off medication, and at no point did the LVEF fall below 50%.
This patient, my wife, is now 76 years old, and is busy shovelling snow on our driveway as I have recently injured my back. She remains in NYHA Class 1, as she was before the episode of pneumonia. We both ride our bicycles regularly though the rugged country around our home on Vancouver Island, and she is totally asymptomatic, even after 80...
Show MoreCompeting Interests: None declared.