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Suggest Treatment For Swollen Ankles When Suffering From Apical Hypertropic Cardiomyopathy
Question: My wife was diagnosed with Apical HyperTropic CardioMyopathy on XXXXXXX 2012. Currently being treated in XXXXXXX Institute of Medical Sciences, Ernakulam.
She is now undergoing periodic checkup, in every 6 months and ECHO Cardio is taken yearly once. Also about an year back, a 24 hour Holter Test is done where she was fitter with a holter and monitored for 24 hours. The result is provided as ‘No Significant Abnormality’.
Also the consultation progress report from last week, provided as:
NSR/Good LV function
Class 2/No CHF
HR 70/mt
BP 120/76 mm Hg
Chest Clear
Previous ECHO Diagnosis 31/03/2014:
Hypertrophic Non-Obstructuve Cardiomyopathy / Good Left Vetricular Systolic Function/ Grade 2 Diastolic dysfunction/ Mild Pulmonary Hyper Tension.
Now she is feeling fatigue and also breathless sometimes. Also at times, her angles are getting swollen and pain in the legs and lower back. Could you please suggest anybody who can take a look at this and answer our worries? Is this treatment fine, Is the pain and swelling is related to the condition she have?
She is now undergoing periodic checkup, in every 6 months and ECHO Cardio is taken yearly once. Also about an year back, a 24 hour Holter Test is done where she was fitter with a holter and monitored for 24 hours. The result is provided as ‘No Significant Abnormality’.
Also the consultation progress report from last week, provided as:
NSR/Good LV function
Class 2/No CHF
HR 70/mt
BP 120/76 mm Hg
Chest Clear
Previous ECHO Diagnosis 31/03/2014:
Hypertrophic Non-Obstructuve Cardiomyopathy / Good Left Vetricular Systolic Function/ Grade 2 Diastolic dysfunction/ Mild Pulmonary Hyper Tension.
Now she is feeling fatigue and also breathless sometimes. Also at times, her angles are getting swollen and pain in the legs and lower back. Could you please suggest anybody who can take a look at this and answer our worries? Is this treatment fine, Is the pain and swelling is related to the condition she have?
Brief Answer:
Please see below.
Detailed Answer:
Dear Sir
1. The condition of apical hypertrohpic cardiomyopathy (HCM) is a variant of classic HCM which is a genetically determined cardiac disorder. Apical HCM is much less riskier as compared to classic HCM with obstruction as it causes much lesser incidence of sudden cardiac death. Major problem in these patients is because of lower relaxability of heart muscle leading to shortness of breath on exertion. These patients may also get exertional chest discomfort and episodic palpitation. If shortness of breath is persistent she can consult the cardiologist again for increasing dose of current medication or adding some diuretics after thorough evaluation.
2. She is being given beta-blockers which is standard drug therapy. Her holter is normal and in absence of history of sudden cardiac death in close relative or history of unexplained loss of consciuosness or ventricular tachycardia, she is not a candidate for AICD (defibrillator).
3. Pain in leg, back along with the episodic swelling is not related to this condition. These complaints may be related to orthopedic or rheumatological condition. You may consult a bone and joint specialist (orthopedician). These patient may develop swelling feet in response to right sided heart failure which is not there as per the clinical notes of your doctor.
Feel free to discuss further.
Sincerely
Sukhvinder
Please see below.
Detailed Answer:
Dear Sir
1. The condition of apical hypertrohpic cardiomyopathy (HCM) is a variant of classic HCM which is a genetically determined cardiac disorder. Apical HCM is much less riskier as compared to classic HCM with obstruction as it causes much lesser incidence of sudden cardiac death. Major problem in these patients is because of lower relaxability of heart muscle leading to shortness of breath on exertion. These patients may also get exertional chest discomfort and episodic palpitation. If shortness of breath is persistent she can consult the cardiologist again for increasing dose of current medication or adding some diuretics after thorough evaluation.
2. She is being given beta-blockers which is standard drug therapy. Her holter is normal and in absence of history of sudden cardiac death in close relative or history of unexplained loss of consciuosness or ventricular tachycardia, she is not a candidate for AICD (defibrillator).
3. Pain in leg, back along with the episodic swelling is not related to this condition. These complaints may be related to orthopedic or rheumatological condition. You may consult a bone and joint specialist (orthopedician). These patient may develop swelling feet in response to right sided heart failure which is not there as per the clinical notes of your doctor.
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. Chakravarthy Mazumdar
Answered by
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