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Low BP, respiratory tract infection, breathless, had heart attack and angioplasty. Suggestion?

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Pulmonologist
Practicing since : 2003
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My father has had a heart attack. He is 69 years old with no history of diabetes
. He has low BP and history of bronchial infection . He has been a smoker. He has undergone angioplasty on 12th XXXXXXX [4 days after the heart attack]. He has severe respiratory track infection and he is breathless most of the times. Docs have put him under Montek 40 LC and Levolin + Foracort inhalers with spacers. Whenever he is going breathless he starts coughing sometimes he is becoming unconciousness. Other drugs such clopbitop 75 A, Aldactone , storvas 40 . Prolomet XL 2.5 mg , AB flo 100mg [ for resperiatory infection and cough syncope]I am planning to take him to bangalore since currently he is in Kolkata , We are planning to fly down, let me know if he can fly and also what precautions to be taken.
His BP as on yesterday is 100/60 and Pulse is 80
Can you please suggest
Posted Wed, 18 Apr 2012 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 3 hours later
Hi,
Thanks for posting your query.

After going through your query, I would like to comment the following:

1. Your father seems to be suffering from IHD (Ischemic Heart Disease) with COPD (Chronic Obstructive Pulmonary Disease) with secondary respiratory infection.

2. I suppose a complete work up including PFT (Pulmonary Function Test), Chest x-ray & CT thorax have been done regarding diagnosis of pulmonary condition most likely COPD.

3. His current medications seem to be satisfactory but the treatment always has to be individualised as per the clinical profile.

4. His current Blood pressure of 100/60 needs that his medications for cardiac element need to be revised. Please consult your physician regarding continuation of Aldactone and Prolomet XL.

5. Episode of cough and syncope means that the coughing is quite extensive and need to be controlled. Please consult your physician for medications for control of cough.

6. Regarding Flight travel, a pre flight assessment by a pulmonologist needs to be done for fitness to fly. It includes clinical examination, oxygen saturation, pulmonary function test, pneumothorax. Active respiratory infections should ideally be treated before air travel.

7. If his oxygen saturation is less than in flight, oxygen supplementation may be required. Please consult your Pulmonologist regarding this. If such an oxygen supplementation is required, then you need to inform the airlines well in advance.

8. Also you need to carry all the emergency medications for his heart disease and respiratory problem. He need to carry his inhalers with him during flight.

I hope I have answered your query. I will be glad to answer any follow up queries.

Please accept my answer if you have no follow up queries.

Regards.

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
Follow-up: Low BP, respiratory tract infection, breathless, had heart attack and angioplasty. Suggestion? 18 days later
Hi Doctor

With your advise , I had taken my father to Pulmonlogist , he said since he had a heart attack recently , untill 6 weeks are over , a PFT cannot be advised. The cough and asthamatic condition has reduced a lot now. His cardiologist has performed another ECG and EchoCardiography recently and has confirmed that his heart functionality has reduced a lot and it functions only 33 %. He also said there is nothing that can restore it back to normal now , He has to follow a lifestyle and very low exertion work can be done. Categorically what I need to understand is what are the precautions that needs to be taken and with this kind of functionality how long can one survive
 
 
Answered by Dr. Gyanshankar Mishra 7 hours later
Hi XXXXXXX,

Thanks for the follow up.

After going through your follow up query, I would like to comment the following:

1. Its good to know that you had your father evaluated by a pulmonologist and his asthmatic symptoms have gone down considerably. Please continue the medications advised by him which will include inhalers and oral pills.

2. Considering his cardiac function, it seems that his ventricle ejection fraction is 33% currently. This makes life style modification and rest extremely important. And this has been correctly advised by the cardiologist.

3. The following precautions need to be followed now:
a. Continue the inhaled and oral medicines for asthma regularly as advised by your pulmonologist.
b. Do get him vaccinated for influenza and pneumococcus to prevent these infections in future.
c. Avoid exertional activities. Continue rest.
d. Avoid fatty, spicy foods. Avoid carbonated drinks. Avoid cold stuff.
e. Make a dietary plan tailor made for him by a dietician. This facility is also available on this website.
f. Continue the cardiac medications.
g. Predicting the exact survival is difficult considering the development of any future complications. However 5 year survival benefit can be expected if optimal health care measures are carried out.
h. Do get him regularly evaluated by your clinician to detect the early development of any potential complication.
i. Do measure his inhaled PEFR at home after completion of 6 week period of the heart attack.

I hope I have answered your query. I will be glad to answer any follow up queries.

Please accept my answer if you have no follow up queries.

Regards.

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
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