Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

166 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

What causes breathlessness while lying down as per the attached reports?

Answered by
Dr.
Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

default
Posted on Tue, 8 May 2018 in Hypertension and Heart Disease
Question:
My father got a heart attack on 16th nov we though it was acidity and latee when the pain agreevated we came to the hospital by the time we wasted 5 hours . Doc went for angiography and quickly for angioplasty to fix the 100%blockages but still the report says there is an artery which is 90%blocked. He experienced chest heaviness and litte pain amd heavy acidity vomitting post the surgery meaning the next day. We have vot discharged from.the hospital yesterday and now my father is feeling breathless at night while lying down and there is beep kind of sound when he is far asleep.
Also doc has advised to have onpy 1.5 litres of water i want to know the reason for the same

My query is we did his eco on 16th when he got the attack where the lvef was 35% and we did the eco yesterday while getting discharged his lvef was the same as 35%.
I am really concerned as i have read on the net that low lvef is sign of danger and heart attack.



Can you please advice attached are the reports

Doc has given today palnep and cardivas to cure that but till now as well his heart rate has nkt reduced

We have got readdmited after one week of discharge because my dad started suffering from very low blood pressure. Doc saod it is due to dehydration as we have restricted the water intake as well and since he had taken cremalax for motions and he went to teh washroom 4 to 5 times

Now we are in the hospital from 3 days his bp is 103 over 120 and 70 over 80
But pulse rate has onceased to 85 to 92 usually his pulse rate after the surgery was normal. And when we reqched the hospital doctor did the 2d eco where the lvef value shown was 25 to 30% but when we got discharged from hospital a week before lbef was 30 to 35% . I am worried why the lvef has gone down in a weeka time can you please help understanding the same

Can ypu advice tablets cardivas and ivabrad dose should be reduced??
He is currently feeling little breathlessness i am worried what could be the reason for the same . Is the heart muscle getting morw weak or any infection? Please advice
doctor
Answered by Dr. Rishu Saxena 1 hour later
Brief Answer:
Please see deatailed answer.

Detailed Answer:
Hello,
Thanks for choosing HCM for your query,
Have gone through your details.
As per the details given by you it seems that he has two blockages in his heart.Only one has been stented.Any blockage more then 70% is called critical blockage and should be treated with stenting however i don’t know why doctor has not stented the second artery at the same time.

As per query regarding ejection fraction its calculated manually by echocardiologist.Less then 35% ejection fraction is considered severely low however less then 20% is called critically low.Between 20 to 35% means the same for clinical purpose Does not matter if its 30 or 25 or 34%.

When ejection fraction is low heart fails to pump blood out of heart therefore blood starts stagnating inside heart causing severe breathlessness.Prophylactically patient is kept under strict fluid control(less then 1.5 litres per day).

A diuretic should be added in small doses in his treatment to provide relief in breathlessness.
Kindly enclose the treatment chart.Medicines he is on with doses so that i can give you further suggestion.
Waiting!

Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Rishu Saxena 2 days later
Hello Doc,

As you know the entire history of my dad about the Heart Episode. We got discharged today and I am attaching the recent ECG report can you please check and advice me whether there are any ECG changes happend when we got admitted earlier while during the angioplasty and now when we got admitted for low blood pressure .
I want to know has the situation become more worse or its the same.
Please let me know and also I am attaching the discharge summary and current medication kindly review and advice
Your response will be very much appreciated .

Regards,
Sxxxx
doctor
Answered by Dr. Rishu Saxena 21 hours later
Brief Answer:
Things would take some time to settle down.So have patience and follow proper medications.

Detailed Answer:
Hello there,
As seen in ecg changes related to previous attack are settling down however ejection fraction would take time to improve and you have to keep patience for that.
One suggestion is that ask you cardiologist to add Trimetazidine 35 mg twice a day.Its a atypical anti anginal but plays excellent role in improving ejection fraction of a person.
He is on a diuretic named dytor you may ask your cardiologist to add a potassium sparing diuretic like aldactone.They prevent cardiac remodelling and again help to improve ejection fraction.

Rest all medications are fine.
See patient may feel restless or may have post traumatic stress sometimes.This does not mean that stents are not working properly.
Slowly and slowly as months would pass by things would become normal.

If medications will be properly followed most likely his EF would improve in next 6 months.
Don't put too many restrictions on your father.
Let him do work etc.He should keep himself busy.
Don't make him feel that he is ill.Infact in todays world if given a choice cardiac ailments are best to have as person can lead almost a normal life post procedure.
Is your father ambulating?
Has he started post cardiac rehabilitation?
Regards.


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Rishu Saxena 1 hour later
No doc he has not started any rehab for now
He walks for 5 min half hr post every meal

Can you suggest any rehab center and how rehabs work I have no idea what do they do?

Thank you for letting me know that there are no changes on ecg as compared to the earlier one. This gives me a peace of mind that the situation has not gone worse

But now his pulse has gone low like it is 65 all the time and oxygen saturation has been 97

His Bp is always low 88 over 120 and 65 over 80
Do you see any chances of ICD or pacemaker in this case of my father?

Regards
Sxxxx
doctor
Answered by Dr. Rishu Saxena 4 minutes later
Brief Answer:
follow up.

Detailed Answer:
Hello,
No ICD is not required.
Indication of ICD is ejection fraction less then 30% with Left bundle branch block like changes in ecg.
Give your father some time.
Let him take medications for 3 to 6 months initially.
Pulse is a bit on lower side as cardiologist has started him on a high dose of ivabradine.
2.5mg or 5mg once a day is enough for him.
Rehabilitation part can be done at home-
Once discharged patient should move inside house 20-30 minutes a day for next 7 days after that for next week patient should start to walk in garden area.Third week post op patient should start walking 300 metres a day.
1month post operation patient is allowed to do all activities except lifting too heavy weight or running too fast.One month post op he is a normal person again and he should start doing his routine job.
Any thing can be done by patient in which body is comfortable.
1month post 2d echo and stress test would be done again to see the condition of stents.
He should start ambulating.
Why would he need an ICD?
Please tell me what your cardiologist said to convince you for ICD?

He is not on an ace inhibitor and betablocker.Every cardiac patient as a rule of thumb should be given betablocker and ace inhibitor postplasty.
My suggestion is that you should better get a secondary consultation about treatment in person from a cardiologist.This doctor has not given any medication which increase ejection fraction(betablocker at1 antagonist or trimetazidine).
\If he is breathless a nitrate should also be added.
I am not satisfied with treatment part specially the part which would improve his EF.
Out of the medication list only top 5 are related to cardiac point of view in which 2 are anti platelet and statin.
This treatment should be reviewed.
Take a print out of my answer and you can consult the doctor.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Rishu Saxena 26 minutes later
Hello Doc

No one has even suggested ICD reading over the internet that post plasty within 40 days one csn go for ICD if the pulse rate is low or too high hence I asked

Brillinta and cardivas was also there but since he got breathlessnesa doc completely discontinued cardivas and replaced brillinta by prax

I will surely consult the doc in person and see why he has not added the medications u have suggested. But if I directly ask him why has he not added he will get agitated as being a mon science student how can i dictate him

Let me know ur thoughts

Regards
doctor
Answered by Dr. Rishu Saxena 15 hours later
Brief Answer:
follow up.

Detailed Answer:
Hi again dear,
Don’t dictate him.Just try to ask him about adding trimetazidine and low dose of ace inhibitor for improving ejevtion fraction.
Just say that you came across these things on internet.
Don’t force him rather just ask him.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
default
Follow up: Dr. Rishu Saxena 34 hours later
thank you doctor.

we have been monitoring my dad's BP for 3 times in a day and also the pulse rate .
BP is always between 100 over 120 and 68 over 80
Also, the pulse rate is XXXXXXX 69 and 70 .

Can you please let me know is this a matter of worry , should we see the doc who did the angioplasty ?

Also, I read through the internet there is an MRI cardiac scan for scar assessment, do you think we should do that ,will that affect the stent?

Also, should we repeat the 2d Eco after 15 days ?

Request your advice .

Regards,
Sxxxx
doctor
Answered by Dr. Rishu Saxena 9 minutes later
Brief Answer:
follow up.

Detailed Answer:
Hello there,
Its ok
Blood pressure is maintained by ejection fraction of heart which means amount of blood heart is pumping out.
In your case ejection fraction is low therefore blood pressure would be on lower side plus he is on diuretic which would further lower it.
I don’t think you need to monitor b.p thrice.
Do it once a day thats it.
Pulse is ok.Reduce doses of Ivabradine to 5 mg once daily.
Cardiac MRI etc is not required.
30% ef means that a large part of heart is dead and would scar up in 3 months(so it would be a waste of money).
Right now just try to ambulate him.

I would suggest him a stress thallium after 1 month.
Highly accurate,Non invasive test.

Regards!
Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Rishu Saxena 10 hours later
Hi Doctor,

Thanks for your response , I did not understand this statement
30% ef means that a large part of heart is dead and would scar up in 3 months , Scar up means it goes more worst?


Regards,
Sxxxx
doctor
Answered by Dr. Rishu Saxena 6 hours later
Brief Answer:
Answer to follow up query.

Detailed Answer:
Hey,
When all walls(muscles) of heart are functioning properly then ejection fraction of heart is 60%.
During a heart attack or infarction blood supply to these muscles are hampered causing muscle damage.Now as those muscles are damaged(dead),Contracting power of heart decreases (Ef is now 30%). These damaged muscles would slowly over months form scar tissues(part of normal physiology of body).So doing a MRI would not solve purpose.

Any thing that is not functional in our body would be scarred up.This is a natural process called fibrosis.

Take care.
Above answer was peer-reviewed by : Dr. Kampana
doctor
default
Follow up: Dr. Rishu Saxena 53 minutes later
Thanks Doc, for being patiently answering to all my questions and guiding me through each process.

Is numbness of hand left had is a matter of worry, most of the time like majority of the time my dad's right hand becomes numb completely , any signs or any thing we can do ?

doctor
Answered by Dr. Rishu Saxena 48 minutes later
Brief Answer:
follow up advice.

Detailed Answer:
Hi XXXXXXX for providing you with a professional advice i want to go through reports of his 2d echo and angiography.
Please attach them with follow up.
Waiting.
Above answer was peer-reviewed by : Dr. Kampana
doctor
default
Follow up: Dr. Rishu Saxena 43 minutes later
I am attaching the reports , kindly advice .

Regards,
Sxxxx
doctor
Answered by Dr. Rishu Saxena 7 minutes later
Brief Answer:
follow up.

Detailed Answer:
What he is experiencing is common complications of angioplasty procedure.
The symptoms are related to irritation of arm nerves which as I said earlier is a common complications and this irritation will be resolved within 4-8 weeks and everything is going to be ok again.This is why you shouldn't worry about this symptoms. If after 2 months the symptoms persists then you should contact a neurologist to exclude any further nerve damage.
His echo is not that bad.He would be fine in few days.
Reports of angiogram are not there(ask you dr to give it to you as in case of emergency every cardiologist would ask for it).
Hope this will be of help!
Wish him health!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Rishu Saxena 57 minutes later
Hi Doctoc,

I have attached all the reports including angioplasty and even ECG reports as well .
doctor
Answered by Dr. Rishu Saxena 1 minute later
Brief Answer:
follow up.

Detailed Answer:
Dear XXXXXXX
Angioplasty means putting stent into a artery ,you have attached that report i can see that there is a stent in LAD,but before that angiography is done which shows that whats the percentage of blockage in other arteries and their branches.
So ask you doctor to provide you with CD and Reports of angiography also.
This would help you in future and CD and reports of angiography are important from point of transparency also.
Angiography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers.Once blockage is ruled out we put stent there this is called angioplasty.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Rishu Saxena 37 minutes later
I do have the Cd , but I am not able to upload it here as its too large . Also you spoke about Fibrosis, is it bad or god, forming a scar is a natural process you made me understand but ideally it should form a scar or the scar forming is bad?

Also, can you look into the ECG reports of 24th nov and compare it with 2nd Dec as we got readmitted on 2nd dec are there any changes in ECG
Please advice
doctor
Answered by Dr. Rishu Saxena 13 minutes later
Brief Answer:
follow up.

Detailed Answer:
He had a heart attack,So scar would form.Ideally any muscle loss is bad but now it has already occured dear so only option left is to minimize loss,For which plasty and medicines are there.
24 NOV ECG-He is having ongoing heart attack(anterio sepatal wall).
Dec-Changes are suggestive of old M.I(they will always be there in ecg)

Now ecg does not have much significance for him.Minimum echo and best one is stress thallium for him(monitoring).
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,  
Drug/Medication
Medical Procedures ,  
Lab Tests
Medical Topics

Recent questions on  Post traumatic stress

doctor1 MD

Awakend at 9am yesterday w/ pain & itch at elbow; felt feverish, noticed red streaks across fingers & hands; moved from bed to chair by phone, to call doctor, & fe ll asleep; awakened llpm, streaks had become purple, extending from fingers to...

doctor1 MD

I have been recently diagnosed with PNES. I have previously had ptsd and some of those symptom are returning. other than therapy what other treatment is available to stop seizures

doctor1 MD

Hi,

I recently had non-consensual/unprotected sex. It was my first time... It was rough although it didn't last long and it hurt at the time.

I was really sore for two days after and had a fair bit of bleeding. On the third day, it started to burn when I sat and went to the bathroom. I looked in a mirror and saw 2 white sores on my vaginal opening that hurt to the touch. They weren't blisters, there was no breaking or scabbing. I assumed it was an infected tear or friction sore healing due to the placement.

I went to a walk in clinic three days later (a week after the incident) and they told me I had a UTI. She looked at the sores and swabbed them for herpes. She said they looked a bit like herpes but that she couldn't be sure. Two days later this (8 days after the incident) the sores had completely healed.

I went to my family doctor and got the clinic to send over the results. All the STD tests came back negative. She said she assumed it was due to a tear as the first herpes outbreaks do not heal as quickly and that I should get a blood test for HIV in three months. She said if I get another sore I should come back to her to undergo a culture right away as this was more accurate than the blood test at this point.

Two and a half weeks after the original incident I came down with a very bad cold and had a very stuffy nose, not sure if this is related at all. All my friends at school were sick as well and I may have caught this from them. During this week I experienced random dull/shooting pains in my vaginal area and some occasional itching. I'm dealing with some post-traumatic stress after the incident, and obsessing over STDs and thought it could all be in my head. I went to the doctor again and I did the urine std tests again. She said I might have a sinus infection but didn't want to put me antibiotics in case it was a yeast infection after taking the UTI medication. Everything came back negative again.

I'm really confused and overwhelmed by all of this, I don't know who to talk to. What do I do next? Any help would be greatly appreciated. I have nightmares, can't sleep and experiencing extreme stress and a loss of appetite.

Thanks in advance for any assistance you may be able to provide.

doctor1 MD

What are the symptoms of P.T.S. and how can you deal with it naturally.