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Complained of breathlessness and dizziness. Diagnosed with irregular heart beats and high sugar. All test normal. Suggest?

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Practicing since : 1966
Answered : 4497 Questions
My father Mr. XXXXXXX XXXXXXX aged 57 complained of breathlessness and dizziness last week. On further consultation with our family doctor, he was diagnosed with irregular & high rate heart beats & high sugar levels (plus 300 for both fasting & post meal). He is a diabetic since many years now & has in the past had high levels of sugar detected (plus 200) but never with a heart condition.

All his tests - cholesterol, lipid profile, etc has shown normal results. However, one of his tests - 'X-Ray Chet P.A view' performed yesterday gave the following result -
1. Prominent brochovascular marking are noted
2. Haziness of the bilateral tower zones are seen, which may be related to effusion versus overlying soft tissue
3. Mild cardiomegaly
4. Bony cage and soft tissue normal

I request his case be reviewed by your expert panel as soon as possible.
Posted Sat, 7 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 18 hours later
Brief Answer:
Admission ideal / Investigate the heart

Detailed Answer:
Hi friend,
Welcome to Health Care Magic

The best option is to admit him to a Tertiary Care Multi Speciality Hospital / and get him investigated and treated.

Blood sugar of 300 may not be an emergency, but breathlessness and dizziness with irregular beats need early and extensive investigations...

At this age, he should be investigated for Coronary Artery Disease (CAD) / Especially so, in Diabetes (which is a risk factor for heart). In Diabetics, the presentation could be atypical, even misleading... Absence of pain at present does not exclude heart problem.       TMT – Treadmill exercise ECG; may be with thallium isotope – is often necessary to evaluate ischemia (reduced blood flow / Coronary Artery Disease)

Irregular heart beats need further work up. Standard ECG records the electrical activity of the heart, for a few seconds. It can detect the arrhythmia occurring during that time only. One needs Holter or event monitor, for the nature and extent of arrhythmias, silent ischemia..

Cardiomegaly in Chest X-ray is deceptive / He needs Echocardiography to conform...
Lower zone haziness may be from soft tissue / CT chest will clarify the issue.

Take care     
Wishing speedy recovery
God bless
Good luck
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