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Suggest Treatment For Iron Deficient Anemia
Question: We are in receipt of claim for Severe global LV Systolic dysfunction and Iron deficient Anaemia.as per past history known of carcinoma breast and Anaemia.as per policy terms and conditions pre-existing ailment and its complecations are not payable.kindly confirm whether current diagnosis is related to pre-existing ailments ?? if not what could be the reason??
Brief Answer:
please see detailed discussion.
Detailed Answer:
Dear Madam
1. The degree of anaemia (11.8 gm%) is too low to cause such a presentation of acute bilateral pleural effusion.
2. There is no ischemic insult to heart as suggested by normal troponin levels, however, there was severe LV systolic dysfunction on first ECHO. However dilatation improved in next ECHO to small extent with marked improvement in EF. This improvement in size was despite fall in Hb from 11.8 to 10.7. Hence, the insult to heart at onset was acute in nature or acute on chronic in nature.
3. The only thing I could find out in the past history which may be related to the cause is intake of ANASTRAZOLE which is an aromatase inhibitor (AI). Though most of individual trials of these drugs do find any increased risk of cardiovascular event but one of the metaanalysis of 30,000 patient found that AIs may increase the risk of cardiovascular events as compared to tamoxifen. You can refer to following link for his article.
http://journals.lww.com/oncotimesuk/Fulltext/2011/02000/Aromatase_inhibitors_may_raise_cardiovascular_risk.9.aspx
4. Beside Anastrazole, any history of Anthracycline infusion or Tamoxifen intake for carcinoma breast will predispose to cardiac damage. The details of past chemotherapy for Ca Breast may be asked for.
Hope this clarifies the issue. Feel free to discuss further.
Sincerely
Sukhvinder
please see detailed discussion.
Detailed Answer:
Dear Madam
1. The degree of anaemia (11.8 gm%) is too low to cause such a presentation of acute bilateral pleural effusion.
2. There is no ischemic insult to heart as suggested by normal troponin levels, however, there was severe LV systolic dysfunction on first ECHO. However dilatation improved in next ECHO to small extent with marked improvement in EF. This improvement in size was despite fall in Hb from 11.8 to 10.7. Hence, the insult to heart at onset was acute in nature or acute on chronic in nature.
3. The only thing I could find out in the past history which may be related to the cause is intake of ANASTRAZOLE which is an aromatase inhibitor (AI). Though most of individual trials of these drugs do find any increased risk of cardiovascular event but one of the metaanalysis of 30,000 patient found that AIs may increase the risk of cardiovascular events as compared to tamoxifen. You can refer to following link for his article.
http://journals.lww.com/oncotimesuk/Fulltext/2011/02000/Aromatase_inhibitors_may_raise_cardiovascular_risk.9.aspx
4. Beside Anastrazole, any history of Anthracycline infusion or Tamoxifen intake for carcinoma breast will predispose to cardiac damage. The details of past chemotherapy for Ca Breast may be asked for.
Hope this clarifies the issue. Feel free to discuss further.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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