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Suggest Treatment For Fatigue, Fluid Retention And Cough
Question: I'm not sure if you are able to see my previous questions to other docs, but long story short I have been suffering from fatigue especially after exertion since a cold illness I had back in Feb 2014. Although my echo was normal i fear this has to do with my heart. I have experienced fluid retention and starting 4 weeks ago developed a nagging cough which half the time I cough up clear mucous. There is no shortness of breath I don't think or at least very mild. Do you think I should get another echo?
Brief Answer:
A comprehensive differential diagnosis is necessary.
Detailed Answer:
Hello!
Thank you for asking on HCM!
Regarding your concern, I would explain as follows:
As you are experiencing recently exertional fatigue and mild shortness of breathing (and all these clinical scenario has started after you get a "cold"), you need a differential diagnosis to rule out primarily any possible pulmonary, as well as cardiac causes. As you have peerformed several tests already, I would recommend to perform a pulmonary function test coupled with an arterial blood gas analysis (to rule out any pulmonary dysfunction implications).
Regarding heart exploration, I recommend to repeat a cardiac ultrasound after a coue of months (as the four chamber view was suboptimal, and the left ventricle borderline dilated).
To better evaluate cardiac function (as complains were related to exertuon), I recommended to perform a stress imagine cardiac test ( such as dobutamine stress induced cardiac ultrasound, or Cardiolite, etc).
If everything result normal, then alternative caussz should be sought.
coming to this point, I would recommend to discuss with an internist.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
A comprehensive differential diagnosis is necessary.
Detailed Answer:
Hello!
Thank you for asking on HCM!
Regarding your concern, I would explain as follows:
As you are experiencing recently exertional fatigue and mild shortness of breathing (and all these clinical scenario has started after you get a "cold"), you need a differential diagnosis to rule out primarily any possible pulmonary, as well as cardiac causes. As you have peerformed several tests already, I would recommend to perform a pulmonary function test coupled with an arterial blood gas analysis (to rule out any pulmonary dysfunction implications).
Regarding heart exploration, I recommend to repeat a cardiac ultrasound after a coue of months (as the four chamber view was suboptimal, and the left ventricle borderline dilated).
To better evaluate cardiac function (as complains were related to exertuon), I recommended to perform a stress imagine cardiac test ( such as dobutamine stress induced cardiac ultrasound, or Cardiolite, etc).
If everything result normal, then alternative caussz should be sought.
coming to this point, I would recommend to discuss with an internist.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you doctor. I should add that I received a chest x Ray and results came back normal however my lungs sound crackly and wet when I breath out hard.
Can you elaborate on the 4 chamber result being suboptimal on echo? Which reading would that be?
Thank you
Can you elaborate on the 4 chamber result being suboptimal on echo? Which reading would that be?
Thank you
Brief Answer:
A cardiac imagine test with better visualisation is needed.
Detailed Answer:
Hello again!
I would explain that a normal chest X ray film can't exclude every serious pulmonary disorders (such as pulmonary embolism, etc).
Regarding your last echo report, I remain of the opinoin that it should be repeated after a period of time, coupled with additional more optimal imagine modalities, on cardiac stress conditions (as I mentioned above).
Your last cardiac echo offered suboptimal 4ch views, and has forced your doctor to use an i/venous contrast agent to add accuracy to the test.
Best wishes! Dr. Iliri
A cardiac imagine test with better visualisation is needed.
Detailed Answer:
Hello again!
I would explain that a normal chest X ray film can't exclude every serious pulmonary disorders (such as pulmonary embolism, etc).
Regarding your last echo report, I remain of the opinoin that it should be repeated after a period of time, coupled with additional more optimal imagine modalities, on cardiac stress conditions (as I mentioned above).
Your last cardiac echo offered suboptimal 4ch views, and has forced your doctor to use an i/venous contrast agent to add accuracy to the test.
Best wishes! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks for your expert opinion. I will follow up with recommended tests.
Regards XXXXXXX
Regards XXXXXXX
Brief Answer:
You are welcome!
Detailed Answer:
You are welcome!
You are welcome!
Detailed Answer:
You are welcome!
Above answer was peer-reviewed by :
Dr. Prasad
Have you ever since a case where a dilated left ventricle shrinks with lifestyle changes and reducing blood pressure?
Thx XXXXXXX
Thx XXXXXXX
Brief Answer:
Your echo pattern doesn't look problematic.
Detailed Answer:
Hello Kristian!
My answer is: Yes!
There are cases where reverse left ventricular remodeling ("left ventricle shrinking") is possible.
Nevertheless, your echo pattern is not worrying. So relax!
Wish you a good health! Dr. Iliri
Your echo pattern doesn't look problematic.
Detailed Answer:
Hello Kristian!
My answer is: Yes!
There are cases where reverse left ventricular remodeling ("left ventricle shrinking") is possible.
Nevertheless, your echo pattern is not worrying. So relax!
Wish you a good health! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Last question:
Can you determine E-wave deceleration time from my Echo?
I calculate that my E/A wave to be slightly greater than 1.5 which in combination with shortened dec time might indicate a problem.
Ty XXXXXXX
Can you determine E-wave deceleration time from my Echo?
I calculate that my E/A wave to be slightly greater than 1.5 which in combination with shortened dec time might indicate a problem.
Ty XXXXXXX
Brief Answer:
Your echo parameters are normal.
Detailed Answer:
Hello dear Kristian!
I would like to explain you that your mitral inflow pattern is quite normal, and compatible with your age. No shortened deceleration time is present. And your mitral valve E/A is normal. You don't have to worry about these issues.
Greetings! Dr. Iliri
Your echo parameters are normal.
Detailed Answer:
Hello dear Kristian!
I would like to explain you that your mitral inflow pattern is quite normal, and compatible with your age. No shortened deceleration time is present. And your mitral valve E/A is normal. You don't have to worry about these issues.
Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
OK. It is just very frustrating because my symptoms seem
Like it would be a circulation issue. I have been fatigued for over a year so I'm trying to find the underlying cause.
If I exercise (jog for 20-30 minutes) I will feel ok right after exercising but the following 3 days I am in a crashed exhausted state and can sleep 14hours/day. By the 4th day I will slowly come back to baseline and feel better. It is like clockwork. I also notice that my resting heart in the 3 days after exercise is 39-40bpm and when I am feeling better my resting heart rate will climb back to 47-48bpm. I don't believe my heart rate goes that low because I am in great athletic shape! And although it is getting a little better over the past couple off the I have swelling in the ankles and cough. Thank you for your help so far I anything else comes to mind of what might be going please let me know.
Sincerely, XXXXXXX
Like it would be a circulation issue. I have been fatigued for over a year so I'm trying to find the underlying cause.
If I exercise (jog for 20-30 minutes) I will feel ok right after exercising but the following 3 days I am in a crashed exhausted state and can sleep 14hours/day. By the 4th day I will slowly come back to baseline and feel better. It is like clockwork. I also notice that my resting heart in the 3 days after exercise is 39-40bpm and when I am feeling better my resting heart rate will climb back to 47-48bpm. I don't believe my heart rate goes that low because I am in great athletic shape! And although it is getting a little better over the past couple off the I have swelling in the ankles and cough. Thank you for your help so far I anything else comes to mind of what might be going please let me know.
Sincerely, XXXXXXX
Brief Answer:
I would recommend to check as follows
Detailed Answer:
Hello!
It seems that your complains are not related to any cardiac disorders.
Regarding any possible heart rate implications and any cardiac conductance abnormalities, you should perfom an ambulatory ECG monitoring (Holter ).
I would also recommend to check your thyroid and adrenal gland function ( the respective hormone levels).
You should discuss with your attending physician about these issues.
Greetings! Dr. Iliri
I would recommend to check as follows
Detailed Answer:
Hello!
It seems that your complains are not related to any cardiac disorders.
Regarding any possible heart rate implications and any cardiac conductance abnormalities, you should perfom an ambulatory ECG monitoring (Holter ).
I would also recommend to check your thyroid and adrenal gland function ( the respective hormone levels).
You should discuss with your attending physician about these issues.
Greetings! 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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