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Suggest Treatment For Thickened Heart Muscles
Question: Dear Doctor,
Request your opinion on a medical condition for mother.
She is 53 years old and troubled by short of breath and fatigue. We consulted a cardiologist who after going through her ECG, suggested ECHO and after examining the report mentioned that the heart muscles are slightly thickened and suggested the following medication.
Atorvastatin I.P 200 mg
Metoprolol Succinate
Remylin
For a second opinion we took her to another cardiologist. He also found some variation in ECG and suggested an ECHO again. After thorough examination, he concluded that there is nothing worry about heart. According to him the variation in ECG may be a personal characteristics but the ECHo report suggests that Heart is in perfect condition. He suggested to discontinue the medicines prescribed by the earlier doctor and only asked to continue a medicine for cholestrol. Since we have 2 different opinions here, wanted to have a detailed examination of this. Attaching the report for your examination. Please help us with the expert opinion.
Request your opinion on a medical condition for mother.
She is 53 years old and troubled by short of breath and fatigue. We consulted a cardiologist who after going through her ECG, suggested ECHO and after examining the report mentioned that the heart muscles are slightly thickened and suggested the following medication.
Atorvastatin I.P 200 mg
Metoprolol Succinate
Remylin
For a second opinion we took her to another cardiologist. He also found some variation in ECG and suggested an ECHO again. After thorough examination, he concluded that there is nothing worry about heart. According to him the variation in ECG may be a personal characteristics but the ECHo report suggests that Heart is in perfect condition. He suggested to discontinue the medicines prescribed by the earlier doctor and only asked to continue a medicine for cholestrol. Since we have 2 different opinions here, wanted to have a detailed examination of this. Attaching the report for your examination. Please help us with the expert opinion.
Brief Answer:
please see details
Detailed Answer:
Dear sir.
1. I have seen your mothers report. There is indeed some increased thickness of heart wall. The normal IVS in a female is 10 mm or less. Posterior wall should also have same dimension. Her IVS is 13 mm and posterior wall is 15 mm. Hence she has thickened wall. However this is not ASH. This does not fit into asymmetrical septal hypertrophy.
2. I would like to know her symptoms in detail. If she has diabetes or high blood pressure. This will help in analyzing her condition further.
Sincerely
Sukhvinder
please see details
Detailed Answer:
Dear sir.
1. I have seen your mothers report. There is indeed some increased thickness of heart wall. The normal IVS in a female is 10 mm or less. Posterior wall should also have same dimension. Her IVS is 13 mm and posterior wall is 15 mm. Hence she has thickened wall. However this is not ASH. This does not fit into asymmetrical septal hypertrophy.
2. I would like to know her symptoms in detail. If she has diabetes or high blood pressure. This will help in analyzing her condition further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Doctor,
Thanks for the quick revert. Her BP is normal and is not a diabetic. The symptoms are she feel breath less after a walk or some work. Is this a symptom of cardiomyopthy.
Regards
XXXXXX
Thanks for the quick revert. Her BP is normal and is not a diabetic. The symptoms are she feel breath less after a walk or some work. Is this a symptom of cardiomyopthy.
Regards
XXXXXX
Brief Answer:
Get ECHO from a reputed good institurte
Detailed Answer:
Dear Sir
1. ASH which has been mentioned in the ECHO report is a part of HYPERTROPHIC CARDIOMYOPATHY. However as I told you before this ECHO report does not meet the criteria for ASH. For ASH, IVS should be more than 15 mm and at least 1.3 times of thickness of posterior wall, which is not the case here. This report favors left ventricular hypertrophy (LVH). The commonest cause for LVH is high blood pressure.
2. This report does not favor the other two prominent types of cardiomyopathy (CMP). They are dilated and restrictive CMP. The dilated CMP should have enlarged left ventricle and low ejection fraction. Both of them are within normal limits in this report. For restrictive CMP, both left and right atrium should be enlarged which is not the case.
3. Since she is symptomatic and there is some abnormality in ECHO, I would recommend a second ECHO from a reputed good institute like a medical college. In the meantime please get the blood pressure checked regularly.
4. The present information is insufficient to recommend or stop any therapy, as there is ambiguity in values and final conclusion of ECHO report.
Feel free to discuss further.
Sincerely
Sukhvinder
Get ECHO from a reputed good institurte
Detailed Answer:
Dear Sir
1. ASH which has been mentioned in the ECHO report is a part of HYPERTROPHIC CARDIOMYOPATHY. However as I told you before this ECHO report does not meet the criteria for ASH. For ASH, IVS should be more than 15 mm and at least 1.3 times of thickness of posterior wall, which is not the case here. This report favors left ventricular hypertrophy (LVH). The commonest cause for LVH is high blood pressure.
2. This report does not favor the other two prominent types of cardiomyopathy (CMP). They are dilated and restrictive CMP. The dilated CMP should have enlarged left ventricle and low ejection fraction. Both of them are within normal limits in this report. For restrictive CMP, both left and right atrium should be enlarged which is not the case.
3. Since she is symptomatic and there is some abnormality in ECHO, I would recommend a second ECHO from a reputed good institute like a medical college. In the meantime please get the blood pressure checked regularly.
4. The present information is insufficient to recommend or stop any therapy, as there is ambiguity in values and final conclusion of ECHO report.
Feel free to discuss further.
Sincerely
Sukhvinder
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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