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What causes shortness of breath and sleeplessness?

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Posted on Mon, 25 Aug 2014
Question: hello doctor. I want to ask for my mother age 70. had bypass in 2008 now EF is 15-20%. taking tab aspisol av 75
Tab lanoxin 0.25
Tab. Dytor 10
Tab.zincovit
Tab ramistar 1.25

Anxiety medcines

Tab dveniz 50mg
Tab maxgalin er 75

no change.nt sleep well in night but niw in day time breath prob.what to do is any other medication treatment.she is very weak her weight is 34.Diet or exercise help in dis .during bypass doctor says about her valve leakage.pls suggest what to do.any hope for improvement or critical

I have echo report of may 2014 but spelling nt clear

Akinetic inf por lat
Severe glosal hh
EF 15 - 20 %
Sev MR
Tr Pah 35mm
No PE
doctor
Answered by Dr. Sukhvinder Singh (21 hours later)
Brief Answer:
please see details.

Detailed Answer:
Respected Madam
1. A number of factors can cause shortness of breath in this scenario. The low pumping (EF of 15-20%), the severe MR (leaking valve), abnormal relaxability of heart etc. Anemia, deteriorating renal functions are some of the causes outside heart.
2. From management point of view I would prefer to give much lower dose of lanoxin in my patients with such a profile rather than 0.25 mg daily. I would try to uptitrate dose of ramistar. Transient increase in diuretics may also be done. If there is no contraindication I would add spironolactone to all such patient. These patients may be benefited by devices like biventricular pacemaker, if they are candidates for same. They may also be benefited by careful addition of beta-blockers. You can consult your cardiologist about these drugs and for a possible prescription.
3. Low salt diet, frequent small meals, bed rest after each meal are helpful. Water intake should be restricted as per urine output. Exercise can not be prescribed unless examined by a cardiologist.
Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Sukhvinder Singh

Cardiologist

Practicing since :1998

Answered : 1306 Questions

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What causes shortness of breath and sleeplessness?

Brief Answer: please see details. Detailed Answer: Respected Madam 1. A number of factors can cause shortness of breath in this scenario. The low pumping (EF of 15-20%), the severe MR (leaking valve), abnormal relaxability of heart etc. Anemia, deteriorating renal functions are some of the causes outside heart. 2. From management point of view I would prefer to give much lower dose of lanoxin in my patients with such a profile rather than 0.25 mg daily. I would try to uptitrate dose of ramistar. Transient increase in diuretics may also be done. If there is no contraindication I would add spironolactone to all such patient. These patients may be benefited by devices like biventricular pacemaker, if they are candidates for same. They may also be benefited by careful addition of beta-blockers. You can consult your cardiologist about these drugs and for a possible prescription. 3. Low salt diet, frequent small meals, bed rest after each meal are helpful. Water intake should be restricted as per urine output. Exercise can not be prescribed unless examined by a cardiologist. Hope this helps. Feel free to discuss further. Sincerely Sukhvinder