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Taking Medicine For Hypertension And High Cholesterol. Diagnosed With Hyponatremia. Risk Of Heart Disease?

Posted on Fri, 15 Feb 2013

Question: Hi, my dad is 70 years old.He doesn't have any history of heart disease.He was on hypertension cholesterol medications.On one fine day he got sum uncomfortable feeling in chest without pain and later on some sweating with vomiting feeling. ..we immediately went to the emergency...Der day saw some ischemia changes and trop t came positive with value of 1.17ng/ml. His 2d echo was normal and exactly d same as of 2years before. Diagnosed with hyponatremia...sodium levels of 114...was on blood thinners and salt for a week and we were ready for the discharge. .doctor suggested us for angiography but my dad's hb fell from 10.5 to 8.8 and doctor said that Der is a Need of bloodtransfusion bbefore angiography. ..1unit of blood was given and after around 2hrs when 220ml was transfusion,he ddeveloped shortness of breath shivering wheezing and he was shifted to emergency again.were told that it could either due to blood reaction or some CAD problem in heart...day were also saying that heart entered into Lleft ventricular failure...bp and pulse rises to extreme. .pulmonary edema also developed as a result..he remained in ICU for 4 days n doctors told that he is responding well to the treatment by output of negative 3 litres and now doctors said that his chest is clear n we can be relieved from d hospital. MY question is whether that episode would have impacted my dad's heart or that was a temporary situation and will Der be any changes in his 2d echo now .he is having cough as of now at regular intervals.angiography shows left main coronary artery normal and other small arteries show some blockage which have been recommended to improve by medications

Answered by Dr. Anil Grover (6 hours later)

Dear XXXXXXX
Thanks for writing in.
I am a qualified and certified cardiologist. I read your well written summary of the situation. My feelings are because:
1. Your dad had hypertension and high cholesterol (Both of which are risk factors for coronary artery disease. There was justification in doing the angiogrphy. It has been reported having insignificant disease .
2. Left Ventricular Hypertrophy was detected by echocardiography is a common consequence of hypertension.
3. The, assumption of having blood reaction appear justified because while cross matching it is not practical to test for each component blood to be matching.
4. Therefore, my provisional opinion to your question about persitence of changes in echocardiographic examination is that: yes some changes like left ventricular hypertrophy will persist. and
5. As to the cause for shortness of breath, when there is left ventricular hypertrophy heart becomes stiff and there is resistance to filling it during circulation. There is some back flow in the veins carrying oxygenated blood from lungs to heart, resulting in shortness of breath.
6. In my opinion the acute illness he suffered was a temporary phenomenon because of anemia and reaction to blood. He would be better when his hemoglobin comes up and his hypertension is kept under control. Even diastolic dysfunction mentioned above is a treatable condition.
If you can copy the report and upload an EkG along with his present height and weight and lipid profile with list of drugs he has been advised. I would be wiser in telling this with more certainty. Looking forward to get a mail from you. Good luck.
Regards and Happy Republic Day,

Dr Anil Grover
MD (Medicine) DM(Cardiology)
Cardiologist

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

Follow up: Dr. Anil Grover (7 hours later)

sir I m not able to upload any report as sizes are more than 2mb. ..well my only concern is that his ejection fraction in last two 2d echos was 60% and all other function were normal....but after this episode of circulatory overload will his structure wud have been impacted or will Der be any change in ejection fraction?

Answered by Dr. Anil Grover (1 hour later)

Thanks for writing back.
In Diastolic dysfunction (without effecting the pumping action that is systolic function) ejection fraction is normal (60%) is normal. So, except that there is no mention of E wave and A wave as cm/seconds (which you can send me) your echo appears normal. So there does not appear to any permanent damage to heart.
You can upload the jpeg images of EKG and send those to my personal email address YYYY@YYYY . There is no problem in uploading upto 10 MB data in one mail. Good Luck

Dr Anil Grover

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

Follow up: Dr. Anil Grover (3 hours later)

Sir I have sent 3 ecgs done during admission, after one day and immediately after blood transfusion reaction.Also Sir my previous question was that as my dad's 2d echo was normal. ..will this circulatory overload done by blood transfusion will make any permanent changes on my dad's heart...if we will do 2d echo now...will d results be same as that of previous ones or dis entire episode of blood transfusion induced circulatory overload which has made my dad heart to enter into LVF will cause any permanent changes....

Answered by Dr. Anil Grover (7 hours later)

Thanks for writing back. I appreciate the effort you have taken to send me scanned EKGs and Echo report. I find that you are under care of Dr XXXXXXX S Wander. He is a friend and I can assure you he is the best cardiologist in Ludhiana: one of the country's best.
About EKG review I have written before. Your father's echocardiography does show effects (not the damage) because of hypertension. I am pretty certain echo done now after the event which led to blood transfusion reaction, will be more or less same. I would strongly urge you to continue your treatment under Dr Wander. Good Luck.
Thanks for using health care magic. If you have further query you can write to me (please ask a direct question) I will be most happy to answer your question.
Regards
Dr Anil Grover,
Cardiologist & Internist
M.B.;B.S, M.D. (Internal Medicine) D.M(Cardiology)
YYYY@YYYY
http://www/ WWW.WWWW.WW

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

Follow up: Dr. Anil Grover (4 hours later)

Yes Sir, he is like God for us.He has saved my dad's life.Last night I was able to speak to him and he has cleared all my doubts.Thanks to you as well.

Answered by Dr. Anil Grover (1 hour later)

Thanks for your kind words.
Kindly close the query with stars and remarks, it was a pleasure interacting with you.

Best Wishes

Anil Grover

Note: For further queries related to coronary artery disease and prevention, click here.

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