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Are there possiblities of hypertension and heart attack in a diabetic and what are nitial signs of stroke?

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Practicing since : 1966
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Hi, Let well-experienced XXXXXXX cardiologist address this - My mother-in-law is diabetic (type 2), dyslipidemic, has subclinical hypothyroidism, osteoarthritis on hip, knee, ankle and seems prehypertensive too. She has osteoporosis and Vit-D insufficiency too, as confirmed by doctors. As she had swelling on both the legs around ankles and whole foot for nearly 10-15 days and on face near nose for 2 days long ago, one cardiologist suggested to go for ECHO. The ECHO taken today has the result as • Normal Sixed Heart Chambers • Borderline Concentric LVH • Tips of AML Prolapse with Grade I Mitral Regurgitation • Other valves are normal and competent • No regional wall motion abnormalities at rest • Normal LV Systolic Function (LVEF: 71%) • Grade I LV Diastolic Dysfunction • No PAH; No Pericardial Collection What does this mean? How is her heart's health and what're the possibilities for the future - at present state not being addressed? Is she having chances to have High BP and any other complication? What is the remedy - please suggest from preventive care perspective too? Should we go for cardiologist consultation, in-person? Hers was 130/90, as endocrinologist checked yesterday. When the doctor checked last time, at both occasions (in 15 min interval) the readings were 140/90. As we checked using Digital apparatus, it wasn't consistently at 130/90 but was 60% at that range. She is not taking any medicine for hypertension now. Is she required to have medicine for hypertension too? What will happen if this ECHO impression has not been addressed to - any chances of heart failure, heart attack? Could you also let us know the initial symptoms of a stroke? Due to some unpleasant occasion, she had headache and pain on her left leg. She could not sleep till 2 A.M, but was conscious and talking normal. Is it very initial sign of a stroke?
Posted Wed, 25 Dec 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 1 hour later
Brief Answer: Long story! / Consult her Nephrologist Detailed Answer: Hi friend, Welcome to Health Care Magic Blood pressure is controlled fairly well for the present – even without medication. It needs to be monitored only. Treatment has to be initiated, when the values go up [upper figure (Systolic) more than 140 / Lower figure (Diastolic) more than 90… / and aim to keep it around 130/80 The ECHO does not show any serious problem – some minor changes are the result of pressure / It does not demand direct attention or interference… Heart attack or stroke is always a possibility in Diabetics / and it could even be silent. It can be postponed, at times prevented by aggressive management of risk factors – cholesterol, pressure, sugar… Aspirin in small doses (75 to 150 mg) help. Stains to treat cholesterol help – even when the levels are normal / they have effects beyond cholesterol – like antioxidant and plaque stabilization / and are routinely given by many practitioners. Her LDL is quite high - 70 should be the aim in diabetics (otherwise 100 is permissible) Isolated pain in the leg is less likely from stroke. Headache and loss of sleep could well be from anxiety, but one cannot be sure. Presentation of a stroke can vary greatly, depending on the nature and location of the insult – paralysis of one side or face and limb is the most common. There are several other atypical presentations like slurring, vertigo, in-coordination, blindness, confusion, altered behavior, persistent headache and so on. Any change from the usual status may need to be seen by a Neurologist. Generally MRI and MRA (MRI Angiography of head and neck blood vessels) are indicated for evaluation Her TSH is still high / the dose of thyroid replacement hs to be increased. Kidney or Allergy is probably responsible for the swelling… In summary, Her heart is sound… Her urea is high; but creatinine is normal - this is a picture of dehydration (water deficit). Her electrolytes (Sodium, potassium, chloride, bicarbonate & magnesium) need to be checked - as soon as possible. She should be reviewed by her Nephrologist (Kidney specialist) –they are the specialists best suited to treat her pressure too. Good luck Take care Wishing all well God bless
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Follow-up: Are there possiblities of hypertension and heart attack in a diabetic and what are nitial signs of stroke? 10 minutes later
Paraphrasing your inputs, summary is As on date it is almost normal and her TSH, cholesterol and BP symptoms MUST be attended to, for avoiding future heart ailments. This is in addition to other measures put in place, for all her ailments. Please advice, if I've not understood aptly or missed anything.
Answered by Dr. Anantharamakrishnan 12 minutes later
Brief Answer: Check electrolytes Detailed Answer: Hi Nothing otherwise missed... All the risk factors should be treated / aggressively - especially Cholesterol here Thyroid also - not urgent BP for follow up Electrolytes - like Sodium & Potassium - need to be done NOW / the result should be reviewed by her nephrologist Regards
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Follow-up: Are there possiblities of hypertension and heart attack in a diabetic and what are nitial signs of stroke? 8 minutes later
Thanks.. We will address as suggested - first cholesterol, followed by BP. Then, will consult nephrologist with the electrolytes results.
Answered by Dr. Anantharamakrishnan 1 hour later
Brief Answer: Well said / hopefully well done too Detailed Answer: Hi Great Let the nephrologist see - and treat her Pre-renal azotemia / as early as possible / correctable condition God bless her and you Regards
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Follow-up: Are there possiblities of hypertension and heart attack in a diabetic and what are nitial signs of stroke? 5 days later
Update/Follow-up: Started taking Aztor EZ 10 mg. Also, attaching ECHO report for detailed study and 'preventive care' suggestion from you. Currently, she climbs steep stairs to 3rd floor home, everyday. For better heart health, is it advised to avoid steep stairs and that too to 3rd floor. What others need to be restricted? Will Aztor EZ have any side effects on her kidney etc.?
Answered by Dr. Anantharamakrishnan 5 hours later
Brief Answer: No restriction / low fat diet Detailed Answer: Hello, She must be blessed to have such a caring so-in-law! Many normal people may find it difficult to climb 3 flights of stairs! As a rule of thumb, if one can climb 2 flights of stairs, there is no heart failure. Her effort tolerance is good In my opinion, there is no need to restrict the activity – unless she complains… As a matter of fact, regular exercise helps in cholesterol too / say walking 30 minutes a day / at least 5 days in a week. Physical rehabilitation leads to psychological rehabilitation and keeps up quality of life The only restriction is food – for cholesterol – Keep weight to normal / even a little less! Healthy FOOD is a must. Avoid saturated fats – coconut oil, palm oil, butter, ghee, full cream milk...Avoid junk foods in particular – French fries have palm oil / Pizza has cheese / Indian sweets are made in ghee.../ Change to Poly-un-saturated oil – like sun flower oil. / Include Mono-un-saturated oil – Olive oil. Repeat the test in 6 weeks. Aztor EZ has no harmful effects on the kidney. It is good to take the statin – they have effects beyond cholesterol – antioxidant and plaque stabilisation Good luck
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