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Cardiac arrest due to COPD - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Heart Attack
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1775 Questions
Doctor :   hi
Doctor :   Hi
Doctor :   Please proceed with your query.
User :   what is inferior myocardial damage shown in ECG and value QRS as 107
Doctor :   it means that the patient has myocardial infarction in the inferior heart chamber.
Doctor :   in common words going for a heart attack.
User :   how severe it is
Doctor :   it is severe enough to cause problems.
Doctor :   may I know whose report is this and age of the patient?
User :   is it curable
Doctor :   yes, but it depends on age, other factors also
Doctor :   it is not curable but interventions can be tried.
User :   my father was diagnosed as COPD with acute excerbation plus high blood pressure
Doctor :   it depends on risk factors, time of diagnosis, associated other illness in the patient, and reports.
Doctor :   ok
Doctor :   since it is an myocardial damage it is a serious issue
Doctor :   it needs very quick intervention else can be life threatening.
User :   doctor intervention such as
Doctor :   it depends
Doctor :   immediate intervention has to be done with in seconds or minutes
Doctor :   like oxygen, aspirin and other medicines and even angioplasty
Doctor :   based on the severity and patient condition at that time.
Doctor :   the patient has to immediately seek medical attention
User :   doctor, my father got this in Aug 2010,
Doctor :   ok
User :   i will pass u through the event that occur
Doctor :   if this is associated with copd, the severity varies.
Doctor :   sure go ahead.
User :   5 Aug--- he started feeling breathlessness ,we asked him to come to hospital , but he refused, 6 Aug- he continued with that feeling of breathlessness, finally we took him forcefully to hospital
Doctor :   ok
User :   at that time , doctor said from Arterial Blood report the oxxygen is 20 % and survival chances are low, they ask us to continue with oxygen therapy and asthalin spray
Doctor :   ok
Doctor :   that 20 percent is very low saturatio , it must be more than 90 at least
User :   after 15 minutes, he got completely ok with the breathless, then we have taken the X Ray, but unfortunately ECG machine operator was not available, so he got admitted to KEM , there they started monitoring and given him insulin and other liquids sodium and other
Doctor :   ok
Doctor :   please continue
User :   finally after two days, blood was taken arterial for further analysis , but he took discharge from the hospital due to poor hygeine he felt in hospital
Doctor :   ok
User :   next day we went to private hospital for him to get admitted, since bed was not available, doctor suggested to use Budetrol and do the ECG, ECG Report was taken where QRS and other thing was mentioned
User :   and that too in Aug
Doctor :   ok
Doctor :   please continue
User :   After two fays we got the bed in the hospital, but my father refuses to come and said he is completely ok, also we observed that the tiredness we were observing for last 6 month from Jan 2010 is reduced, he started using Impravent and asthalin nebulizer
Doctor :   ok
User :   rarely we seen the effect of this myocardial damage
User :   On ECG it was written reports not confirmed
Doctor :   ok
Doctor :   please let me know once you finish, I a reading what your typing
Doctor :   I willgive you my advice once your done with the history.
User :   he feels shortness of breath when we were going to ECG test since he walked too much, can the QRS reading is related to this
User :   doctor thats all
Doctor :   ok
Doctor :   can i know how your dad is now?
User :   60
User :   chronic smoker
User :   height 5 feet 7 inch and weight 82 kg
Doctor :   ok
Doctor :   how is his health now?
Doctor :   let me explain to you
Doctor :   generally people with copd
Doctor :   will have an underlying heart ailment
User :   ok
Doctor :   since your dad had the ecg changes , he needs to be investigated further.
Doctor :   copd patients will have a ow oxygen saturation.
Doctor :   smoking being a very important risk factor for copd as well as a myocardial damage
Doctor :   smoking will increase the chances of progression of the underlying heart diseas
Doctor :   an ecg will only give us a rough picture of the heart changes, but with it, we cannot come to any diagnosis
Doctor :   in your dads case , he needs to be investigated further in the mean time he needs to get good oygen , nebulisations and medicines as well
User :   but for last 6 month from Aug till Jan he was taking nebulizer and was smoking less
Doctor :   did you follow my suggestion.
Doctor :   yes, by smoking less and nebuliser, the underlying damage will not get normal, it has to betreated further to prevent damage
User :   yes mam oxygen cylinder not available
Doctor :   copd may itself cause aggrevation and breathlessness can increase.
Doctor :   whenever he gets breathless he needs oxygen and treatment, he must be taken to hospital immediately
Doctor :   copd will complicate an underlying heart damage
Doctor :   as oxygen is very important to the heart and lungs , it will be reduced in copd due to smoking
Doctor :   are you with me?
User :   yes mam
User :   Dotor i want to know the following thing and finally i will explain u why
Doctor :   did you follow my suggestion?
Doctor :   ok sure, go ahead
User :   if he is suffering from COPD and inferior myocardial damage, then why after taking nebulizer and ohter medicine, he used to go to work, for last 6 month
Doctor :   an acute attack of copd, will get ok with immediate nebulisation but the underlying problem wil persist, and can come again with severity anytime
Doctor :   the treatment of nebulisaton is symptomatic
User :   ECG showed damage to inferior myocardial damage , then how come he was ok till 6 month, with no severe sign of chest pain, i like to know can ECG report be dependend on when the report is taken
Doctor :   for the heart it needs further tests that depends on the doctor and patient presentation at that point of time.
Doctor :   ecg is a baseline investigation
Doctor :   an inferior wall damage may mean a smal or major damage
User :   what it implies that after getting QRS 107 and sustainability of 6 month
Doctor :   a patient can withstand this for many days also, but many times they may not be able to . it depends on his body , the amount of damage and many changes
Doctor :   from ecg we cannot say much , he needs further treadmill test and angiogram if suggested by his doctor
User :   till januaury he was ok with nebulization and all that
Doctor :   ok
User :   in Feb he started smoking a lot, on 2
User :   26 feb he slept a lot, taken nebulization on 27 feb complain about gas problem
Doctor :   ok
Doctor :   gas rpoblem can be a symptom of a heart problem
User :   sorry 28 feb he complain about gas problem plus on 1st march he ask me to get omez and other tablet which
Doctor :   omez is for gastritis and can relieve some gas problem only temporarily
Doctor :   in most patients with heart problem like myocardial damage , heart changes will be mistaken for gas problem.
User :   he took nebulizer at 10 am , 12 noon and 4.15 pm , then he read newspaper and went to sleep at 4.35 pm and at 5.15 pm tried to wake him up but he didnt, what is the underlying reason heart failure or COPD consider smoking continued by him
Doctor :   his underlying reason would be a massive cardiac arrest aggrevated by an underlying COPD
Doctor :   Im sorry to hear this.
User :   had we been treated from Aug 10 , was it possible to control myocardial damage
Doctor :   We cannot say exactly, as many times even with best control we cannot save patients, they will go for a massive arrest in seconds
User :   considering he continued smoking
User :   is inferior myocardial damage is controllable
Doctor :   we can only prevent further damage but cannot control or revert back to what has already happened to the heart or lungs.
User :   my medication was ok
User :   or not
Doctor :   you mean omez and nebulisers?
User :   nebulizer omez he used
Doctor :   this is the best you could do
Doctor :   i appreciate that
User :   but he didnt quit smoking
Doctor :   yes, smoking has done the damage in him to his heart and lungs
User :   what doctor suggest in case of Inferior myocardial damage
Doctor :   they will suggest further investigatios like angioplasty, a treadmill test etc
Doctor :   if they feel it is needed.
Doctor :   one can never predict an myocardial infarction
Doctor :   or a cardiac arrest
User :   what is the life span available if inferior myocardial damage is detected
Doctor :   itdepends on the further reports and his echo
Doctor :   the left ventricle function too
User :   means in any case smoking to be quit otherwise the effect will be nullified
Doctor :   after an angiogram we can know the function of his blood vessels and the condition and severity.
User :   but since he was ok for 6 month we can conclude that the problem was not severe
Doctor :   by quitting smoking we can delay the changes but what already has occured we cant change but only control.
Doctor :   if the patient is fine symptomatically, we ask them to continue same treatment
Doctor :   but did the doctors advice for further tests/
User :   since he started feeling better after coming from KEM hospital, he was not ready to come to hospital, as he was feeling better and continued with his job
Doctor :   ok
Doctor :   to just summarise
Doctor :   i will explain this to you
Doctor :   when we notice ecg changes like this, as in your father, we advice to take further tests
Doctor :   since he had copd, his condition would have got severe though he felt normal most of times
Doctor :   many patients with myocardial damage will not feel any problem or changes in them.
Doctor :   as it is a slow process and when it presents for the first time itself damage will be there
User :   what is QRS 104 suggest any severity
Doctor :   i may not be able to suggest the severity based on this , as ecg is only a base line reading
User :   is angiogram possible with COPD acute excerbation
Doctor :   as we have to look for other ecg changes as well , just by seeing qrs we cant say much
Doctor :   no, first the copd will have to be controlled with oxygen and nebulisation and depending on doctor and patient, further investigation will be done.
User :   Readings were
User :   RR 722 ms, P 130 ms, PR 162 ms, QRS 104 ms, QT 428 ms, QTC 510 ms,
Doctor :   we have to see ecg and check the patient, do examinations and then proceed
Doctor :   as i said earlier, this suggests an underlying myocardial damage which may need further tests
Doctor :   by these findings we only get a picture that some changes are happening which is significant and hidden
User :   P (II) 0.14 mv S(V1) -1.33 mv , R(VS) 1.62 mv, sakal 3.02 mv
Doctor :   to actually know what amount of changes , we need an examination.
Doctor :   hence he had been advised for further work up
Doctor :   I may not be able to comment more on the changes as i did not eamine him, but can only say further investigations were needed
User :   doctor i am asking this because
Doctor :   I hope you followed what I said, i understand your feelings for your dear father.but as i explained in myocardial changes even with best possible support , we may not be able to save them.
Doctor :   are you there with me?
User :   I took the ECG and were plan to show it to the doctor, but he didnt agree, and started feeling ok, and my marriage was plan , we somewhat didnt show it to the doctor and it happened, I used to ask him to quit smoking by showing animation on youtube
User :   I feel since i miss this all happen
Doctor :   he might have needed a cardilogist opinion and as you said he continued to smoke it would have increased and not diagnosed
Doctor :   you need not be guilty, i understand your feelings very well, but in myocardial damage if left un attended earlier itself, even with good medical support we may not succeed in giving them life.
Doctor :   you have done your best
Doctor :   please accept the reality
Doctor :   and im sure your dad will be with you
User :   but what best i have done
Doctor :   cardiac arrest is something which is very sudden
Doctor :   best you could have done is give him air, breathe through his mouth and nostril, and immediately call the doctor/ ambulance
Doctor :   even if you did it, his chance of survival would be very less
Doctor :   so it was not your fault
User :   I was not there as i m working and was 1 hr away from my place
User :   but thing is that how whole process occured ;;;;
Doctor :   it is a sudden thing
Doctor :   no one can predict the changes or the reaso most of the time
User :   we went to hospital with his blood oxygen as low as 20 % , he survived, but ECG operator was not available
User :   after two days we went to other hospital, bed were not available , had it been available ECG could have been directly in the hand of doctor for further investigation
User :   so he asked us to do ECG , but i didnt notice what is written there as myocardial damage
Doctor :   I think i have provided the suggestions as to what could have been done
Doctor :   I hope i could answer your questions.
Doctor :   i appreciate your concern for your dear father.
Doctor :   please try to accept it and not to worry about the past, you have done the best.
User :   I dont know how i didnt notice, two days later bed was available but he didnt come up and we forget it
Doctor :   ok
Doctor :   please try to forget the incident
Doctor :   and believe that you did your best
Doctor :   do not think of this much
Doctor :   and pray for him.
Doctor :   by thinking about it, we will not get anything as best was done.
Doctor :   what we can do now is take care of your mother
User :   i feel that human life is most precious thing on this earth
Doctor :   and see it to it she is also fine
Doctor :   yes i agree with you
Doctor :   but at times we cannot do anything
Doctor :   we are not alarmed of the risk and disease go un noticed
Doctor :   please divert your mind to something else
Doctor :   i know it is very difficult
Doctor :   but with time you wil be fine , i understand your pain .
User :   can i think that life and death is not in our hand, if something is to happen it will find its way
Doctor :   yes, thatis all we all do, hope for best
Doctor :   if your not able to deal with your guilt, please take some counselling
Doctor :   it will help you
Doctor :   try meditation and engage in work
Doctor :   with time you will be alright.
User :   doctor few more question sorry im troubling u a lot
Doctor :   yes, please proceed
User :   from last few days whenever i started feeling pain in my back whenever i started feeling pain in my back and not able to turn around after taking bath and all everything get ok backpain and all that , but it happens everyday now
User :   sorry wrongly phrase
Doctor :   did you lift any heavy weights recently?
User :   no, but i dont like to sleep on bed , i sleep on the floor
Doctor :   thats good thing to do
Doctor :   do you smoke?
User :   means
User :   no smoking no alcohol and say no other bad habits
Doctor :   ok
Doctor :   since when exactly is the pain and where exactly in your back?
User :   in my back from last 2 month
Doctor :   lower back?
User :   mid porttion of the spine
Doctor :   apart from this any pain in the arms, jaw, face , etc
Doctor :   please contact us again for any advice further
Doctor :   24/7 you can chat with us
Doctor :   bye for now
Doctor :   thanks for consulting me
Doctor :   good day.
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