Hx Of Rheumatic Heart Disease, Mitral Valve Prolapse, Pacemaker Placement, Severe Cough, SOB, Weakness, Pneumonia, On Z-pak, Levaquin, CT Scan, Scar Tissue, On Amoxicillin. Suggest.
Thanks for the query.
After going through the details given by you, I could think a possibility about the current clinical state of your father.
It appears that your father might be suffering from decreased pumping capacity of heart(low ejection fraction) due to chronic heart disease he has. The common cause in post pace maker implanted patients is failing pace maker. This can put back pressure on the lungs, which can lead to fluid accumulation in lungs(which leads to SOB).
Fluid accumulation in lungs(pulmonary odema) can sometimes lead to Pneumonia, added to the failing heart.
Ideally If I were your father's personal Physician I would admit him in a multispeciality hospital(where all tests are available under one roof) under my care and refer for Cardiologist, (Electrophysiologist) and Pulmonologist for their evaluation. The reasons for Cardiologist referral is to assess the pace maker functioning and cardiac status.
Meanwhile I would get the following test done: Chest X-Ray, Pulmonary function test, Echocardiography, BNP(Brain Naturetic Peptide) along with a thorough assessment of pace maker functioning. Since a Pace maker's life is around 5 years after which they need a battery change or lead change.
Since his Total WBC counts are raised with no fever and other blood investigations being normal, this can be possibility of sub clinical infection. Hence a sputum culture along with repeat blood investigations will be helpful.
I would rule out the following possibilities:
Cardiac Failure (Echocardiography, BNP, Pace maker assessment).
Pulmonary Oedema (Chest X XXXXXXX Pulmonary function test)
Lung Infections (Sputum Culture, Blood Investigations)
Depending on the results of these investigations he can be treated more accurately on an inpatient basis.
Hope I answered your query.
Wish your Father a Good Health.
Thanks again!
I understand the situation of your husband better after those comments given by your PCP after preliminary examination.
Inhalation of saw dust can cause such severe symptoms. It irritates the bronchus and cause such reactions. Prednisolone should have helped him along with proper prophylactic low dose antibiotic. Bronchodilators are also be given which can help to get rid of these bothering symptoms.
Bronchoscopy is not required now, and it is the last resort. I agree with the doctor. It is not XXXXXXX if done by experienced pulmonologist. Otherwise it can cause slowing of heart, bleed and gagging.
Let me know the Pulmonary function test reports after they are available.