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Suggest Remedy For Anxiety In A Person With Heart Failure
Question: my husband had a blocked artery, heart attack & one stent implanted two weeks ago. He has shortness of breath so bad he can't walk without stopping to catch his breath after just a few steps - this started one week ago, low blood pressure and extreme fatigue. Just had a chest x-ray & blood. Chest x-ray clear, slight anemia, Echo had shown no more fluid around his heart. He can't function and is not getting stronger. Dr says probably anxiety and he's fine. But he's not fine. He is on low dose aspirin, Plavix 75mg, Losartan 50mg, Atorvastatin 80mg, Metoprolol Succ ER 50mg - all 1x.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern and would explain that in his situation, taking into consideration his past medical history, it is important to exclude a possible heart failure with a low cardiac function which may be the cause of his symptoms.
I wuld recommend performing NT pro-BNB levels and a cardiac ultrasound to examine his cardiac function and investigate for this possible disorder.
Could you please upload his last echo report for me to review and give a more professional opinion?
What are his blood pressure values?
If these tests result normal, you should take into consideration the possibility of anxiety.
You should know that depression and anxiety are very common complications after myocardial infarction.
Besides, I would also recommend treatment for his anemia. You should discuss with his GP to take the proper treatment based on the type of anemia.
Hope to have been helpful!
Feel free to ask any other questions whenever you need!
Best wishes!
Dr.Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern and would explain that in his situation, taking into consideration his past medical history, it is important to exclude a possible heart failure with a low cardiac function which may be the cause of his symptoms.
I wuld recommend performing NT pro-BNB levels and a cardiac ultrasound to examine his cardiac function and investigate for this possible disorder.
Could you please upload his last echo report for me to review and give a more professional opinion?
What are his blood pressure values?
If these tests result normal, you should take into consideration the possibility of anxiety.
You should know that depression and anxiety are very common complications after myocardial infarction.
Besides, I would also recommend treatment for his anemia. You should discuss with his GP to take the proper treatment based on the type of anemia.
Hope to have been helpful!
Feel free to ask any other questions whenever you need!
Best wishes!
Dr.Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer. The Dr. said his blood work was fine but I don't know if NT pro-BNB was one of the tests, and two of the three ultrasound were fine. The last ultrasound was done 10/23 and we don't have results yet. His last blood pressure was 106/65 If I recall correctly - approximately. He is now also taking 400iu vitamin D daily. Would it be wise to see his long time family doctor or the new Cardiologist next? He has seen both in the past two weeks.
Brief Answer:
First exclude possible heart failure implications.
Detailed Answer:
Hello again!
As I explained you before your husband's clinical status seems compatible with heart failure scenario.
Nevertheless, other alternative causes could not be excluded as well without a careful differential diagnosis.
As he has suffered a recent heart attack, and is actually on low blood pressure and extreme fatigue conditions, it is necessary to avoid antihypertensive medications first, such as Losartan and check frequently blood pressure values.
If low blood pressure values and extreme fatigue keep persisting, then further diagnostic explorations are necessary to rule in/out heart failure implications.
So, coming to this point, I would recommend checking HF markers, thus BNP and NT-pro BNP (they are both natriuretic peptides), which are increased in the settings of heart failure. Please check if these tests are done!
But they may be increased also in other conditions such as an acute infection/inflammation or sepsis.
A complete blood count test and PCR are necessary to rule out an infection too.
When it would be possible please upload his previous and last cardiac echo reports for direct review, to exclude systolic and diastolic dysfunction implications on his actual clinical scenario.
Remember that anemia, even when mild, may contribute to the deterioration of heart failure symptomatology.
So, what is his current hemoglobin level?
Why is he taking daily Vit D supplements? If he has Vit D deficiency it may be responsible partly for muscle and body weakness.
What is his recent blood Vit D level?
If you could upload all his actually performed tests and others I recommended above, I could give a more comprehensive professional opinion on this matter.
After excluding heart failure implications on his current clinical scenario and optimizing his maintenance cardiac therapy by his cardiologist, he can continue checking routinely by his GP (for his general health disorders: anemia, possible Vit D deficiency, anxiety issues etc)
If you have further uncertainties, feel free to ask me at any time.
Kind regards,
Dr. Iliri
First exclude possible heart failure implications.
Detailed Answer:
Hello again!
As I explained you before your husband's clinical status seems compatible with heart failure scenario.
Nevertheless, other alternative causes could not be excluded as well without a careful differential diagnosis.
As he has suffered a recent heart attack, and is actually on low blood pressure and extreme fatigue conditions, it is necessary to avoid antihypertensive medications first, such as Losartan and check frequently blood pressure values.
If low blood pressure values and extreme fatigue keep persisting, then further diagnostic explorations are necessary to rule in/out heart failure implications.
So, coming to this point, I would recommend checking HF markers, thus BNP and NT-pro BNP (they are both natriuretic peptides), which are increased in the settings of heart failure. Please check if these tests are done!
But they may be increased also in other conditions such as an acute infection/inflammation or sepsis.
A complete blood count test and PCR are necessary to rule out an infection too.
When it would be possible please upload his previous and last cardiac echo reports for direct review, to exclude systolic and diastolic dysfunction implications on his actual clinical scenario.
Remember that anemia, even when mild, may contribute to the deterioration of heart failure symptomatology.
So, what is his current hemoglobin level?
Why is he taking daily Vit D supplements? If he has Vit D deficiency it may be responsible partly for muscle and body weakness.
What is his recent blood Vit D level?
If you could upload all his actually performed tests and others I recommended above, I could give a more comprehensive professional opinion on this matter.
After excluding heart failure implications on his current clinical scenario and optimizing his maintenance cardiac therapy by his cardiologist, he can continue checking routinely by his GP (for his general health disorders: anemia, possible Vit D deficiency, anxiety issues etc)
If you have further uncertainties, feel free to ask me at any time.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. I do not have the test results in my possession. Dr. said he was slightly anemic and vit D was fine to take for it with no indication anemia could contribute to deterioration. So Scary. He was on Losartan before the heart attack and the cardiologist who placed the stent decided to keep him on it and changed the dosage from Losartan HCT100 12.5 1x to Losartan Potassium 50 1X. I would be afraid to remove this med from him. We will see his Cardiologist asap. (he has no swelling, or fever)
Brief Answer:
Every therapeutic step should be guided by his attending physician.
Detailed Answer:
Hi,
I recommend discussing with his cardiologist about the above mentioned issues.
Every opinion given here should be considered helpful for a better understanding of your husband's clinical condition.
But, it remains on his attending doctor decision to choose the right diagnostic and therapeutic strategy to follow.
Regards,
Dr. Iliri
Every therapeutic step should be guided by his attending physician.
Detailed Answer:
Hi,
I recommend discussing with his cardiologist about the above mentioned issues.
Every opinion given here should be considered helpful for a better understanding of your husband's clinical condition.
But, it remains on his attending doctor decision to choose the right diagnostic and therapeutic strategy to follow.
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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