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What Does My Lab Test Report Indicate?
Question: Hi Dr
This query is regarding my mom who is 58 years old and has undergone XXXXXXX with BSO surgery for endometrial CA grade1 in October 2015.Post surgery she underwent radiotherapy for a month time and it was completed by Feb2016.Till now her oncology reports are negative for malignancy.
Previous Diagnosis
High BP - from past 8 years
Medication - concor 2.5 mg one per day in nite
Post surgery dose increased to concor 5mg
Diabetes - diagonised in feb 2015 but was not on medicine due to borderline sugar levels.
Post surgery medication - amaryl 0.5 mg
for high lipids - aztor 5mg
Recently in oncology regular review xray chest showed up Cardiomegaly.So she was advised to get echo , have attached the recent echo reports.
From past 2 months her BP is been fluctuating.In July she underwent physio therapy for backbone pain and that time BP had gone high 190/80 with giddiness and discomfort in chest.She was in emregency ward for half day for observation.Her sugar leves,ECG report were normalat that time .
Cardiologist prescribed cardace 1.25 mg 1-0-1 and asked to get sleep study done.My query is please let me know what will be the treatment for the abnormalities found in echo report.Is sleep study necessary for her as suggested by cardiologist.She doesnt have sleep apnea problem.Before surgery the xray report was mild cardiomegaly and now it has progressed within a year.Her feet is swollen and sometimes can notice swelling in her hands as well.
I have attached all her reports.Below is the list of medicines what shes is taking now.
ETOSHINE 90 MG 1 TAB once daily(morning)
GABAPIN 100 MG 1 TAB once daily(morning)
LYRICA 75 MG 1 TAB once daily(AFTERNOON)
Above medicine :Recently she met with an accident last week and has severe pain in head,back and knee.All the test have been done and negative for any major complains.
amaryl 0.5 mg once in morning
cardace 1.25 mg 1 tab once daily ( morning)
new a-z goldsoft gel capsules once daily
concor 5mg 1tab once daily ( night)
aztor 5mg 1 tab once daily (night)
One week back tests shows all her sugar levels,liver function test complete profile and lipids are normal.
This query is regarding my mom who is 58 years old and has undergone XXXXXXX with BSO surgery for endometrial CA grade1 in October 2015.Post surgery she underwent radiotherapy for a month time and it was completed by Feb2016.Till now her oncology reports are negative for malignancy.
Previous Diagnosis
High BP - from past 8 years
Medication - concor 2.5 mg one per day in nite
Post surgery dose increased to concor 5mg
Diabetes - diagonised in feb 2015 but was not on medicine due to borderline sugar levels.
Post surgery medication - amaryl 0.5 mg
for high lipids - aztor 5mg
Recently in oncology regular review xray chest showed up Cardiomegaly.So she was advised to get echo , have attached the recent echo reports.
From past 2 months her BP is been fluctuating.In July she underwent physio therapy for backbone pain and that time BP had gone high 190/80 with giddiness and discomfort in chest.She was in emregency ward for half day for observation.Her sugar leves,ECG report were normalat that time .
Cardiologist prescribed cardace 1.25 mg 1-0-1 and asked to get sleep study done.My query is please let me know what will be the treatment for the abnormalities found in echo report.Is sleep study necessary for her as suggested by cardiologist.She doesnt have sleep apnea problem.Before surgery the xray report was mild cardiomegaly and now it has progressed within a year.Her feet is swollen and sometimes can notice swelling in her hands as well.
I have attached all her reports.Below is the list of medicines what shes is taking now.
ETOSHINE 90 MG 1 TAB once daily(morning)
GABAPIN 100 MG 1 TAB once daily(morning)
LYRICA 75 MG 1 TAB once daily(AFTERNOON)
Above medicine :Recently she met with an accident last week and has severe pain in head,back and knee.All the test have been done and negative for any major complains.
amaryl 0.5 mg once in morning
cardace 1.25 mg 1 tab once daily ( morning)
new a-z goldsoft gel capsules once daily
concor 5mg 1tab once daily ( night)
aztor 5mg 1 tab once daily (night)
One week back tests shows all her sugar levels,liver function test complete profile and lipids are normal.
Brief Answer:
Please see detailed reply.
Detailed Answer:
Dear Madam
1. Mildly dilated left ventricle in presence of normal LV systolic function, with mild MR and trivial AR, can occur in a number of generalized conditions and is not considered a heart disease as such. These include anaemia, hyperthyroidism, chronic liver and kidney diseases etc. However I would like to confirm if she really has left ventricular enlargement. Please provide her weight at time of this ECHO study and her height. I will discuss the management part for this only after receiving the data. The report says there is Mild PAH with RVSP of 45mmHg. If you can tell me that she has any respiratory symptoms or symptoms detailed in paragraph number 2.
2. Indication of sleep study depends upon the clinical profile of the patient. It is advised when there is high index of sleep related breathing disorder. some of the indicators are Day-time sleepiness, snoring along with cessation of breathing during sleep, unexplained pulmonary hypertension, morning headaches, polycythemia, right heart failure (especially when associated with obesity.). So there are a number of conditions where physician advise this test. Established cases of chronic obstructive pulmonary disease (COPD) may also require it some time. It would be prudent to ask your treating cardiologist about his suspicion for which he is recommending the tst and then take a second opinion if you are not satisfied.(because of the simple fact that he has examined the patient.)
3. If the echocardiographer had mentioned about the state of inferior vena cava and right ventricular function, the correlation of swelling in feet and heart could have been estimated .
Waiting for more information from your side.
Sincerely
Sukhvinder
Please see detailed reply.
Detailed Answer:
Dear Madam
1. Mildly dilated left ventricle in presence of normal LV systolic function, with mild MR and trivial AR, can occur in a number of generalized conditions and is not considered a heart disease as such. These include anaemia, hyperthyroidism, chronic liver and kidney diseases etc. However I would like to confirm if she really has left ventricular enlargement. Please provide her weight at time of this ECHO study and her height. I will discuss the management part for this only after receiving the data. The report says there is Mild PAH with RVSP of 45mmHg. If you can tell me that she has any respiratory symptoms or symptoms detailed in paragraph number 2.
2. Indication of sleep study depends upon the clinical profile of the patient. It is advised when there is high index of sleep related breathing disorder. some of the indicators are Day-time sleepiness, snoring along with cessation of breathing during sleep, unexplained pulmonary hypertension, morning headaches, polycythemia, right heart failure (especially when associated with obesity.). So there are a number of conditions where physician advise this test. Established cases of chronic obstructive pulmonary disease (COPD) may also require it some time. It would be prudent to ask your treating cardiologist about his suspicion for which he is recommending the tst and then take a second opinion if you are not satisfied.(because of the simple fact that he has examined the patient.)
3. If the echocardiographer had mentioned about the state of inferior vena cava and right ventricular function, the correlation of swelling in feet and heart could have been estimated .
Waiting for more information from your side.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Priyanka G Raj
Hello sir
Thanks for the detailed reply.
For the first point:
on 24 Aug 2016 she was advised for few blood tests mentioned below
1.CBC
2.CREATININE-SERUM/PLASMA
3.HBA1C
4.VITAMIN D TOTAL
5.CALCIUM SERUM
6. SPOT URNE ALBUMIN CREATININE RATIO
7.THYROID PROFILE
all test results are normal except for
HBA1c - 6.6
Vitamin D -11.7 ng/ml
In JULY 2016 liver function test package test results were in normal limits.
At the time of ECHO her VITALS
PULSE RATE 65/MIN
BP -150/80
HEIGHT -155CM
WEIGHT-80.9 KG
BMI-33.67
BSA-1.87
PHYSICAL EXAMINATION :
Pitting edema both feet to mid calf ,calves soft ,no swelling of fingers,chest clear
Recently there were no respiratory symptoms.
FOR SECOND POINT:
Day time sleepiness is not observed much in her except for short naps after lunch.Mild snoring in nights but no cessation of breathe.
In 2013 she was facing left side severe pricking chest pain,more weakness, cessation of breath in sleep and high BP.Have attached the CT angiogram reports taken in 2013 in previous query.There were no abnormalities in CT angio.Her bp medicine was changed to concor 2.5mg(dont remember the old medicne )
Sometimes due to personal tensions she will not get sleep for whole night and this may continue for 1 0r 2 days and later she will be sleepy during day time may be half day.This happens once or twice a month.
My concern is if she has mild pulmonary hypertension what steps can be taken to stop the progress of developing this to later stages.Shes obese and has spinal cord problem(l5-s1 disc protusion radiating to left leg ) which has put restriction on brisk walking for weight reduction.
With the above symptoms the cardiologist advised for sleep study and said that oxygen therapy will be given based on the sleep test which will help in reducing high bp problem and weight aswell.The sleep study was adivised prior to echo test.
Please mention if any further tests are needed.
Thanks
-XXXXX
Thanks for the detailed reply.
For the first point:
on 24 Aug 2016 she was advised for few blood tests mentioned below
1.CBC
2.CREATININE-SERUM/PLASMA
3.HBA1C
4.VITAMIN D TOTAL
5.CALCIUM SERUM
6. SPOT URNE ALBUMIN CREATININE RATIO
7.THYROID PROFILE
all test results are normal except for
HBA1c - 6.6
Vitamin D -11.7 ng/ml
In JULY 2016 liver function test package test results were in normal limits.
At the time of ECHO her VITALS
PULSE RATE 65/MIN
BP -150/80
HEIGHT -155CM
WEIGHT-80.9 KG
BMI-33.67
BSA-1.87
PHYSICAL EXAMINATION :
Pitting edema both feet to mid calf ,calves soft ,no swelling of fingers,chest clear
Recently there were no respiratory symptoms.
FOR SECOND POINT:
Day time sleepiness is not observed much in her except for short naps after lunch.Mild snoring in nights but no cessation of breathe.
In 2013 she was facing left side severe pricking chest pain,more weakness, cessation of breath in sleep and high BP.Have attached the CT angiogram reports taken in 2013 in previous query.There were no abnormalities in CT angio.Her bp medicine was changed to concor 2.5mg(dont remember the old medicne )
Sometimes due to personal tensions she will not get sleep for whole night and this may continue for 1 0r 2 days and later she will be sleepy during day time may be half day.This happens once or twice a month.
My concern is if she has mild pulmonary hypertension what steps can be taken to stop the progress of developing this to later stages.Shes obese and has spinal cord problem(l5-s1 disc protusion radiating to left leg ) which has put restriction on brisk walking for weight reduction.
With the above symptoms the cardiologist advised for sleep study and said that oxygen therapy will be given based on the sleep test which will help in reducing high bp problem and weight aswell.The sleep study was adivised prior to echo test.
Please mention if any further tests are needed.
Thanks
-XXXXX
Brief Answer:
please see details.
Detailed Answer:
Dear Madam
1. The body surface area (BSA) with a weight of 80.9Kg and height of 155cm is 1.93m2. For this body surface area the normal LV dimension (i.e. LVIDD) is 5.98 mm. While LVIDD in the report is 5.2cm. Hence there is no LV enlargement as per the given parameter in the report. Even if we consider the body surface area to be 1.87m2, which might have been calculated by a different software, the upper limit is 5.79 cm. Hence LVIDD is within normal limits for this BSA.
2. As I told you in the last answer, the swelling in lower limb could have been correlated well with cardiac cause, had there been a mention of Inferior vena cava size and its variation with respiration & right ventricular function. There is no mention of diastolic function which should be assesses diligently in such cases. Mild pulmonary hypertension can have multiple causes and to prevent its progression we need to look for the causes. Obesity itself can cause so, directly and indirectly. Directly by impairing respiratory efforts and indirectly by causing diastolic dysfunction of heart.
3. With BMI of 33.67, she definitely has a profile which makes her prone to sleep apnea. History of day time sleepiness increases this suspicion more. Patients with sleep apnea are also more prone to high blood pressure and anginal heart disease. With this clinical background, RVSP of 45mmHg further raises suspicion further. With all this information, I would advise you to consult a sleep specialist to have a second opinion. As a cardiologist, I would like to have a further look into echocardiography of such a patient as detailed in first para. Both the opinion of sleep medicine specialist and echo will be complimentary to each other.
Hope this gives you more insight into this tricky clinical scenario.
Feel free to discuss further.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Madam
1. The body surface area (BSA) with a weight of 80.9Kg and height of 155cm is 1.93m2. For this body surface area the normal LV dimension (i.e. LVIDD) is 5.98 mm. While LVIDD in the report is 5.2cm. Hence there is no LV enlargement as per the given parameter in the report. Even if we consider the body surface area to be 1.87m2, which might have been calculated by a different software, the upper limit is 5.79 cm. Hence LVIDD is within normal limits for this BSA.
2. As I told you in the last answer, the swelling in lower limb could have been correlated well with cardiac cause, had there been a mention of Inferior vena cava size and its variation with respiration & right ventricular function. There is no mention of diastolic function which should be assesses diligently in such cases. Mild pulmonary hypertension can have multiple causes and to prevent its progression we need to look for the causes. Obesity itself can cause so, directly and indirectly. Directly by impairing respiratory efforts and indirectly by causing diastolic dysfunction of heart.
3. With BMI of 33.67, she definitely has a profile which makes her prone to sleep apnea. History of day time sleepiness increases this suspicion more. Patients with sleep apnea are also more prone to high blood pressure and anginal heart disease. With this clinical background, RVSP of 45mmHg further raises suspicion further. With all this information, I would advise you to consult a sleep specialist to have a second opinion. As a cardiologist, I would like to have a further look into echocardiography of such a patient as detailed in first para. Both the opinion of sleep medicine specialist and echo will be complimentary to each other.
Hope this gives you more insight into this tricky clinical scenario.
Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Priyanka G Raj
Hello sir thanks for the reply
Had discussion with our cardiologist.He suggested sleep study for finding out the root cause for PAH.I will be taking her for sleep study.
He suggested to continue with same medications
cardace 1.25 mg 1-0-1
concor 5mg 0-0-1
aztor 5mg 0-0-1
amary 1/2 mg in morning
cardiologist also mentioned nothing to worry about her heart function because her 2013 ct angiogram scan results are normal.
I have checked her old reports of echo test dated may 2015 and october 2015 with COLOUR AND DOPPLER STUDIES :TRIVIAL MR/TR.
GRADE 1 DIASTOLIC DYSFUNCTION and impression :WITHIN NORMAL LIMITS FOR AGE .
Comparing the old echo report with the latest one shows lot of abnormalities within a year time.With the above medictaion her bp is still 150/80 and edema in feet and ankles so im bit worried.
Can you please suggest how frequently these tests like echo and ct angiogram scan should be taken for her as a preventive measure.
Thanks
XXXXXXX
Had discussion with our cardiologist.He suggested sleep study for finding out the root cause for PAH.I will be taking her for sleep study.
He suggested to continue with same medications
cardace 1.25 mg 1-0-1
concor 5mg 0-0-1
aztor 5mg 0-0-1
amary 1/2 mg in morning
cardiologist also mentioned nothing to worry about her heart function because her 2013 ct angiogram scan results are normal.
I have checked her old reports of echo test dated may 2015 and october 2015 with COLOUR AND DOPPLER STUDIES :TRIVIAL MR/TR.
GRADE 1 DIASTOLIC DYSFUNCTION and impression :WITHIN NORMAL LIMITS FOR AGE .
Comparing the old echo report with the latest one shows lot of abnormalities within a year time.With the above medictaion her bp is still 150/80 and edema in feet and ankles so im bit worried.
Can you please suggest how frequently these tests like echo and ct angiogram scan should be taken for her as a preventive measure.
Thanks
XXXXXXX
Brief Answer:
please see details.
Detailed Answer:
Dear Madam
1. I can not compare the echocardiogram of last year with current year, because details of last years echocardiogram are not available. However i do not agree that the current one shows a lot of abnormalities. It just shows that there is mild PAH with RVSP of 45mmHg. The possible causes for which we have already discussed. I do not think there are any other gross abnormalities in ECHO.
2. CT angiogram is not a modality which you should get repeatedly done, say after 1-2 in years, in such cases. It is not at all recommended. ECHO may be, I repeat may be, done after fixed intervals if someone really thinks that her PAH will progress or there is an indication that the condition responsible for PAH is progressive. The "fixed interval" will depend upon rate of progression or indication.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Madam
1. I can not compare the echocardiogram of last year with current year, because details of last years echocardiogram are not available. However i do not agree that the current one shows a lot of abnormalities. It just shows that there is mild PAH with RVSP of 45mmHg. The possible causes for which we have already discussed. I do not think there are any other gross abnormalities in ECHO.
2. CT angiogram is not a modality which you should get repeatedly done, say after 1-2 in years, in such cases. It is not at all recommended. ECHO may be, I repeat may be, done after fixed intervals if someone really thinks that her PAH will progress or there is an indication that the condition responsible for PAH is progressive. The "fixed interval" will depend upon rate of progression or indication.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Not able to upload the old echo reports due to size restriction.
Thanks for clearing the queries.
Thanks for clearing the queries.
Brief Answer:
you are welcome madam
Detailed Answer:
Dear Madam
1. I have seen the three pages of report you uploaded. However it does not mention anything about PAH.
2. You can send your attachments to YYYY@YYYY and write DR SUKHVINDER XXXXXXX in subject line, if it seems necessary. Else I am happy that you got clarification about your queries.
Sincerely
Sukhvinder
you are welcome madam
Detailed Answer:
Dear Madam
1. I have seen the three pages of report you uploaded. However it does not mention anything about PAH.
2. You can send your attachments to YYYY@YYYY and write DR SUKHVINDER XXXXXXX in subject line, if it seems necessary. Else I am happy that you got clarification about your queries.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
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