### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, Im a 57 y/o Female with an extensive heart history. I had 4+ CABGs and a mitral valve replacement (mechanical St Judes) in 2001 at age 47. It was found during surgery that i had already had a HA. I take many meds daily, plus coumadin. I had a small stroke 2 yrs ago that took my hearing. I have recently started having some dizzy spells. One made me fall a couple weeks ago, as I was struggling in the woods in an entanglement. I seem to have the dizziness, upon overexertion, or simply sitting. Is this something I need to have cardio check out for me, as my next appmnt is not until November?Thank you so much. Lu

### output:

Hello I have gone through your complaints and noted your history.  Mitral valve problems cause the left upper chamber heart to enlarge and produce some rhythm disturbances. Most common is atrial fibrillation which means irregular fast impulses from upper chamber of the heart. This irregular heart rate may cause dizziness due to irregular supply of blood to the brain. This also can lead to formation of clot in the upper chamber of heart which may dislodge into the brain and cause a stroke. But since you are on Coumadin that's less likely. Another cause would be low blood pressure - hypotension. I don't know your ejection fraction from your 2 d echo but I suppose it would be less-in view of your history of 4 Cabs, and MVR. This may lead to low blood pressure and giddiness. I would also like to confirm if the valve is functioning well because its 10 years since then. A stenoses or narrow valve can also lead to dizziness spells. I want you to do an EKG, 2D echo and holder monitoring if rhythm disturbances on EKG. Further course of action can be decided after that. If above tests are inconclusive CT BRAIN should be done. Wishing you good health thank you