Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that in her clinical situation it is important to evaluate her cardiac and brain function.

Based on the fact that your friend has suffered from atrial fibrillation and diffuse coronary artery disease, it is quite likely that all her recent clinical scenario may have been related to acute heart failure. The later may be due to ischemic cardiac injury (from multiple coronary artery stenosis) and possible tachycardiomyopathy (from atrial fibrillation).

The acute cardiac dysfunction may have led to low cardiac output and widespread body tissue hypoperfusion and hypoxemia, followed by :

-acute pulmonary dysfunction (expressed with the recent shortness of breathing)
- diffuse hypoxic encephalopathy leading to damage of the cognitive function, which are responsible for the interaction with the others, talking, thinking, orientation and the ability of concentration. This type of brain ischemia can cause vegetative state and coma. That is why, it is important performing a functional MRI and EEG to examine her brain functions (including cognitive functions).
- acute kid injury, which depending on its severity may need special renal supportive therapy up to dialysis. Her actual renal function tests (BUN and creatinine)are necessary to be evaluated.


From the other hand, it is important evaluating her cardiac function in order to estimate the precise overall cardiac performance (left ventricular ejection fraction and other important indices). This is the main factor which predicts her expectancy for a stable hemodinamic condition and subsequent cerebral, respiratory and renal improvements. A cardiac ultrasound is necessary for this purpose.

I would like to review her brain MRI results, renal function tests and cardiac ultrasound reports if you can upload them for a second medical opinion.

If her cardiac function is not severely depressed, you can hope in a fast recovery of her vital organ functions.

Hope you will find this answer helpful!

Feel free to ask any other questions whenever you need!

Kind regards,

Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I understand your concern and would explain that anxiety and psychosis is a normal reaction in ICU patients.

It is well known that many of them can react with anxiety and even vomiting during extubation (trying to remove the ventilation tube).

For this reason repeated trials are made, in order to find the more appropriate moment based on the patients condition.

The most important thing, before making these trials is the evaluation of her brain, cardiac and renal function, in order to make the right decision if it is possible to be independent from the respiratory machine.

You should talk with her ICU specialist for this purpose.

Hope to have clarified some of your uncertainties!

Best wishes,

Dr. Iliri

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