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    What do the following test reports indicate?

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Posted on Mon, 14 Aug 2017 in Hypertension and Heart Disease
Question: Dear Dr.
My name is XXXXXXX (age 44 years// Male) height is 162cm and current weight is 64 Kg.
I’m a cardiac patient as i have had two heart attacks as below :
1) the first heart attack in June’13 and got treated in Apollo Hospital (Bilaspur : Chhattisgarh) and as per discharge summary , Principal diagnosis is : - CAD, Acute anterior wall stemi thrombobolysed with STK LV dysfunction …. CAG (Rt. Radial on 17.06.13 SVD)
2) and the second heart attack in April’17 and got treated in Apollo Hospital (Bilaspur : Chhattisgarh) and as per discharge summary, Principal Diagnosis is: - Coronary artery disease, acute inferior wall stemi, old anterior wall MI, CAG – single vessel disease, Primary PTCA+stenting to RCA (3.5MMX38MMxience xpedition stent on May 01, 2017) severe LV systolic dysfunction LVEF 25-30%)
I’m recently in XXXXXXX along with my brother and thought of meeting with cardiologist in Apollo (CBD, Belapur – Navi Mumbai) for general consultation.
Looking at two heart attack reports, cardiologist in Navi XXXXXXX suspected of hyper-thrombiotic state and advised “Thrombo-check total” test.
As per “Thrombo check total” test result, Cardiologist noted the level of Homocysteine was > 65 µmol/L and included Homocheck C 10 capsule and further suggested to go for MTHFR gene mutation test.
We’ve received the result of MTHFR and the finding is MTHFR C677T is NOT detected however MTHFR A1298C is detected and the comment is “this individual has two copies of the 1298A>C mutation which is known to correlate with reduced MTHFR enzyme activity, however association with homocysteine is not strongly established. Clinical correlation with plasma homocysteine levels recommended.”
Based on the above MTHFR result, cardiologist advised me to meet with the hematologist to decide about the need of anticoagulation. (looking for appointment to meet with hematologist in the upcoming week i.e. July 20, 2017)
I’m under medication with following medicines: -
S. #     API     Brand Name
1     Ticagrelor Tab 90mg     Axcer
2     Rosuvastatin Tab 40mg     Rosuvas
3     Carvediol Phosphate 10mg     Cardivas
4     Eplerenome 25% & Torsemide 20% Tab     Planep T
5     Homocheck 10C     Homocheck
6     Aspirin & Glycerine 75mg Tab     Aspisol
I had been working in the sales field for since last 25 years but currently I’m not working and taking rest at home since May’17 as advised by Dr. and per day medicine cost is Rs 180.80 and per month is ~ Rs 5500 which is very cumbersome for me and my family.
Hence, I’m looking for the solution on my below queries: -
(1)     How long I need to take these above medicines?
(2)     Please suggest if there are any substitute to above medicines so that per day cost is reduced for me?
(3)     What is the chances for third heart attack and what precautions should I take to avoid it.
(4)     When is the body recovery expected so that I can re-start working again?
(5)     I lost my father when is he was 58 years old due to the multiple (five) strokes in the span of five years…does it have any correlation with MTHFR gene mutation wherein A1298C is detected?
(6)     What should I do in terms of test OR start taking any medicine to fix MTHFR A1298C detection?
doctor
Answered by Dr. Bhanu Partap 53 minutes later
Brief Answer:
Please refer to the detailed answer below

Detailed Answer:
Hello XXXXXXX

After going through the medical details provided by you I understand your concern for your health. First of all I would like to tell you that Increased Homocysteine levels are responsible for premature coronary artery disease, Carotid artery stenosis and stroke. MTHFR is a key enzyme that regulates Folate metabolism which in turn regulates Homocysteine levels in the body. So any mutation in MTHFR gene can cause the problem which you are facing.

1. As you have already had 2 heart attacks and now there is a stent inside these medicines needs to be continued, few of them has to be take life long to prevent stent from getting blocked.

2. For the in tial 6 months you need to continue the same meds later if everything goes fine then ticagrelor can be replaced with a cheap one after discussing with your treating cardiologist but not now.

3. The exact chances of 3rd attack cannot be predicted but however it's clear that you are prone to it do need to be very registration with your follow ups, medicines, Diet and healthy lifestyle. NO SMOKING if you do.

4. Regarding you returning back to work this has to be decided by your doctor after evaluation. However as your heart function is decreased you have to limit your physical activity levels.

5. Yes genetic co relation has a very strong basis.

6. Genetic mutations cannot be reverted or resorted. Even if some can be reverted but they are extremely costly procedures and under research.

I hope this information will answer all your questions.

Kind regards
Dr Bhanu partap
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Bhanu Partap 3 hours later
Dear Dr.

Thanks for your below reply mail.

I've below follow up questions:-

1) How many days generally it would take to come down my Homocysteine level to the range of 12-15 from my existing level of >65?

2) I understand my heart function rate is reduced and currently is 25-30% level....please suggest, how would I come to know about the improvement of my heart function rate? Do I need to go for any test to understand about it? If yes, when is the right time for undergoing the test? How much the tentative cost of the test?

3) As I mentioned, in the MTHFR test A1298C mutation is detected, would you advice me to include additional medicine as anticoagulant on my existing list of six medicines which I've already been taking?

4) If yes, which additional medicine would you prescribe me?

5) There is a frequent mild pain i feel in my left side back (around shoulder) everyday @ the interval of 5-6 hours...what could be the possible reasons and how to get rid of it?

6) I feel weakness and loss of energy ..... i'm not very comfortable with my voice which i feel is suppressed currently....when I'm expected to regain my original strength on health and back with my voice / tone of energy ?

7) Currently my water intake is 1.5 to 2.0 Ltr per day...please suggest if its it okay or should I increase / decrease my water intake ?
doctor
Answered by Dr. Bhanu Partap 5 hours later
Brief Answer:
Hello Again

Detailed Answer:
1. With proper medication usually the Homocysteine levels comes within normal range in a period of 1 to 2 months but it's totally variable from person to person.

2. Your heart function assessment can be done with the help of echocardiography which is a simple test and will cost you somewhere around 1500 to 2000 Rs. You can go for this every 6 months for this year to assess the improvement.

3. 4. You are already on 2 antiplatelet medicines and the need of starting anticoagulant for the gene mutation will be decided by a haematologist ideally as per your cardiologist recommended.

5. It's probably due to angina so you can start Ranolazine as it will take care of the pain as well as reduced heart function. You can discuss and get a prescription from your cardiologist for this.

6. Weakness will be there as your heart function is quite low and also all these medicines also cause weakness due to electrolyte derangements.

7. You should restrict your water intake to 1 to 1.5 ltrs per day not more than that.

Kind regards
Dr Bhanu partap
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Bhanu Partap 2 days later
Thanks Dr.

My next query is.....As MTHFR A1298C is detected in my case and you above mentioned that genetic correlation has a very strong basis....
(1) i'm worried about my daughter and younger brothers now.
Please suggest, if I need to take them for test to find out their Homocystein level?
(2) Is MTHFR gene mutation gender specific?
doctor
Answered by Dr. Bhanu Partap 36 hours later
Brief Answer:
Hello Again

Detailed Answer:
First of I would like to apologise for the delayed response.

1. Yes ideally your first degree relative should be evaluated first for Homocysteine levels and if it comes high then evaluation for MTHFR gene mutation.

2. There is no proven gender dominance for this.

Kind regards
Dr Bhanu partap
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Bhanu Partap 3 days later
Dear Dr.

Thanks for your inputs...

One of my younger brother went for "Homocysteine test" yesterday and as per the result we received today his Homocysteine, Serum/Plasma level also shows >65.00 µmol / L.

Please suggest if :-

(1) He needs to start taking Homocheck C 10 capsule.

(2) also, if he needs to go for MTHFR gene mutation test.
doctor
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:
It means it's hereditary in your family

Detailed Answer:
1. Yes he need to start the medicine for high Homocysteine levels.

2. First start with the medicine let the Homocysteine levels comes within normal limits then we will decide whether it's needed or not.

Kind regards
Dr Bhanu partap
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Bhanu Partap

Cardiologist

Practicing since :2010

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