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

### input:
I have seen an orthopaedic surgeon who has advised me to have a total hip replacement. Several years ago the garbage can fell on me knocking me down, and screws were inserted in the femur. It has been getting increasingly difficult to walk without pain, and I now use two crutches. I take no medicines, am 87 and have no health issues. The surgeon said that the position of the screws would mean they would soon penetrate the pelvis, making it impossible for me to walk at all and to be in constant severe pain. Today I went to my G.P. to be cleared for the surgery. She heard a heart murmur, and has suggested they might want to do an Echogram. Haven t heard back from the surgeon yet, but could this prevent me from having the surgery? The thought of pain progressing and being unable to walk has me very concerned.

### output:

Hi welcome to Chat Doctor. I understand your query and concern. Heart murmur needs quick evaluation for any organic heart disease.THR carries increased risk in the form of cardiac embolism. This has to be prevented by the following set of investigative work up. I advise you to have a baseline 2 dimensional echocardiography, ECG and lipid profile to assess the basic cardiac reserve of your heart. Restrict the intake of salt to less than 6g/day. Regular physical exercise in the form of brisk walk for 20 min a day for 5 days a week is pretty useful. Chat Doctor. Reduce the intake of fatty and fried food. One pomegranate a day will help to keep your heart at good pace without clot formation. Review the orthopedic work up with regular x-ray imaging of the screws and the plates. Consult a Cardiologist for further expert management. Post your further queries if any. Thank you.