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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest ways to control hypertension

Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7096 Questions

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Posted on Fri, 18 Aug 2017 in Hypertension and Heart Disease
Question: Hi. I have hypertension and the pressure in my right are is higher than in my left. We have been trying to get itcintrolled for a year and still haven't had any long term success. My doctor ordered an echocardiogram yesterday and these were the results:

-Mild 4.8 cm left atrial dilation
-Trivial posterior pericardial effusion
-No other echocardiograpgic abnormalities noted. There was no evidence of walk motion abnormalities, cardiomyopathy, aortic stenosis, mitral valve proposes, bicuspid aortic valve.
/Mild mitral regurgitation
-LV diastolic dysfunction
-Mild tricuspid regurgitation
-Normal RV systolic pressure 30mmHg

What does this mean? Thank you so very much, in advance.

Kind regards,
XXXXXXX
doctor
Answered by Dr. Ilir Sharka 44 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I passed carefully through your medical history and I would like to explain as follows:

1- First it appears that the two main abnormalities from your cardiac ultrasound are LA dilation and LV diastolic dysfunction. These seems to be correlated with the persistent hypertension and the reason why hypertension has lead to such cardiac changes may be related to uncontrolled BP values, due to insufficient therapy or because of a second cause of hypertension.

That is why it is important to investigate any possible end-organ abnormalities (kidney, adrenal glands, thyroid glands, systemic disorders, etc.).

I would recommend the following tests:

- complete blood count for thyroid anemia
- chest X ray study and pulmonary function tests
- fasting glucose and HbA1C for diabetes
- blood electrolytes levels (for adrenal gland dysfunction)
- kidney and liver function tests
- thyroid hormone levels
- ESR, PCR for inflammation.

The reason, why mild pericardial effusion is present may be related with acute or chronic inflammation, a systemic disorder (like amyloidosis, connective tissue disorders, thyroid dysfunction, acute or chronic inflammatory disease).

Further tests may be needed based on the above tests results.

I would like to directly review your cardiac ultrasound report for a more professional opinion.

I remain at your disposal for any other questions whenever you need!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 4 hours later
I up loaded the report as requested. I have had all of the tests you recommened and they are normal. Thanks again.
Kind regards,
XXXXXXX
doctor
Answered by Dr. Ilir Sharka 15 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again, dear XXXXXXX

I reviewed your uploaded cardiac ultrasound report and would like to explain that considering the following parameters:

- E/A = 3.24
- DTE = 171.6 ms
- E/E’ = 9.83

and also the presence of left atrial enlargement, it may be concluded that the left ventricular diastolic dysfunction is more than grade I (abnormal relaxation).

This conclusion is supported also by the pulmonary vein flow pattern (P vein S/D = 0.75, so less than 1 and also P vein A = 1 m/s, so greater than 0.25 m/s) which goes in favor of an increased LA pressure.

I would advise you to ask for another careful cardiac ultrasound (echo) reviewing again carefully the above and other issues as well.

Coming to this point it is necessary to explore the exact nature of the cause leading to this important diastolic dysfunction and heart failure.

That’s why I recommended you the above mentioned tests at the beginning of our thread.

But, as you confirm that they have resulted all normal, then it remains to primarily focus on hypertension and carefully consider an appropriate medical therapy.

In this regard, several anti-hypertensive drugs classes are available (diuretics, calcium channel blockers, ACEIs, ARBs, beta-blockers, etc.), no predetermined medication scheme seems to be superior to another in the absence of any certain pathological disorder.

A scheme is tried and a careful review is done on a week to decide if it has resulted successful of switching to another scheme or modification is necessary.

An important issue to consider is the difference of blood pressure values between the two arms. What is the average difference?

Have you performed any previous test to explore the whether the aortic structure is normal?

Please, let me know about the actual steps so far regarding the anti-hypertensive medication therapy and also on the aorta issue!

I remain at your disposal for any further discussions.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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