Brief Answer:
No treatment required for Hdl more than 30 . Exercise would help

Detailed Answer:
Hello XXXXXXX ,

I went through all the attached reports and the history of medical issues you have had .
All the reports you have attached are pretty much in normal range .
You are non diabetic and Vitamin D is slightly low for which you are already on supplement.
Now coming to you lipid profile .
With Rosagold and diet / lifestyle you lipids are pretty much well under control.
Generally more than 30 Hdl is ok to have in a male patient according to guidelines so we dont need any treatment for the same .
However considering you had an heart issue at a young age the more is always better as Hdl is the good cholesterol we have .
As XXXXXXX our genetic makeup puts Hdl on lower range , one of many reasons heart problems are higher in XXXXXXX .

How would you increase Hdl ?

As I had said no medication is needed for the same at present .

45 mins of aerobic exercise is the best way to increase Hdl. So if that now what you have been doing start with the same .
Stop smoking if you do .
If you drink red wine has flavaniods which increase Hdl . not more than 2 drinks a day ever .

Hopefully i could help .
Regards . Dr. Priyank Mody

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Brief Answer:
Smoking even two cigarettes is a big NO

Detailed Answer:
Hello ,
1) The aerobic exercise routine is perfectly ok . Increase upon the speed grafually or you may intermittently jog and walk during the 40 min routine .
2) There is a strict no to smoking . XXXXXXX you have to understand, the only reason you had an heart attack was due to smoking . it disrupted a plaque which was not critical and a blood clot occluded your artery . You have a long life ahead and i am very sure you dont want that episode again . Smoking not increases the chances of tge stent getting chocked but also formation of new blockages . even two cigarette are harmful particularly in your cause . Tide over this habit as soon as you can .
3) Ejection fraction of 54 is as good as normal and it means you had near normal recovery after the MI .
Our only aim would be to prevent any future event and eliminate your risk factors .
Wishing you Good health .
Regards Dr. Mody

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Brief Answer:
Yes a healthy lifestyle would reap its benefit in long run

Detailed Answer:
Hello,

If you remove the risk factors and continue with medication, your chances of having another heart issue are similar to a normal healthy individual of your age, as you have achieved near complete recovery from the previous attack with minimal damage to the heart muscle as evident by 54 % EF.
Its no rocket science that if you take more care, the chances of a future attack is far less than someone who is negligent ( Like you were before the MI ).

You are on right track in life towards a healthier old age, the benefit of exercise, maintaining ideal weight and the medication will not only protect you from a future heart problem but also other issues like stroke, hypertension, diabetes, kidney problems and many forms of malignancies.

Thinking a lot about future is also harmful to your health.
So maintain things which are in your hand and continue that indefinitely not just for the 1st 1 or 2 years of a heart problem. Let me know if any further clarification is needed and I would be happy to help.

Regards
Dr. Priyank Mody

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Brief Answer:
No need for a repeat echocardiogram. Medicine are optimum

Detailed Answer:
Hello ,

I went through the echo report you have posted. It's probably the same territory where you had a heart attack which is contracting slowing. However they haven't mentioned its scarred or dead, so there is a good chance that over a period of 6 months to a year it would improve and you are optimum medication to help you achieve the same.

The artery has been opened and you are on optimum medication so hope for the best.

As your doctor said, echocardiography is a subjective test and there is a difference of 5 % when different people do it. Also, many times technician actually does the echocardiography and so s/he wouldn't correlate it clinically. So get it done from the same person in future so s/he can compare it from the last time. Doing it again now will serve no purpose.

Clinically you are doing good, there is no breathlessness while you walk or chest pain, then as a doctor I wouldn't forsee any problem. A treadmill stress test in future would be adjunctive to echocardiography to monitor recovery or detect any early problem.

Regards
Dr. Priyank Mody

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Brief Answer:
Rule of 220 -age is for stress testing and not otherwise in life .

Detailed Answer:
Hello ,
The concept of 220 minus the heart rate doesnt hold true when you are on beta blockers .
Maintain a baseline pulse rate 60 - 7p and with modertae exercise like your walks or jogging to 90 -110 . Again tgese are not rigid number and dont overthink on such things . Just mere thinking that your pulse rate is high will trigger anxoety push it still higher .
Lastly the limits of beta blockade is to optmise the dose of beta blocker to obtain maximum benefit, however its just the pulse but also blood pressure , fatigue and many other clinical parameters you consider while incresing dose .
No amount of physiological increase in pulse is harmful in your case and it would increase with exercise .

Regards Dr. Mody

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Brief Answer:
Beta blocker as a group can hamper sex life , Metoprolol affects the least

Detailed Answer:
Of all the medications you have mentioned , Prolomet witg is a beta blocker can affect your sexual life . Though metoprolol ( prolomet ) is a cardio selective beta blocker and its affect on other system including potency is far less than previous generations of beta blocker , but still of all the medication you have mentioned its the only one . Many a times its anxiety and not the medication which is the culprit .
As you are not on any nitrates or nicorandial , you can take sildenafil , however do discuss it out with your doctor and understand when and how to take it safely.

Regards Dr. Mody

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