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Dr. Andrew Rynne

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What does this Echo report indicate?

Answered by
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Dr. Priyank Mody

Cardiologist

Practicing since :2009

Answered : 910 Questions

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Posted on Tue, 20 Oct 2015 in Hypertension and Heart Disease
Question: my mother's echo report indicates the following:
global LV hypokinesia;more in LAD territory,LVEF=20-25%
dilated LV
Mild+MR
trace AR
Mild TR(PASP-35 mm Hg)
mitral inflow pattern-DRA (GRADE-III)
Aortic valve is tricuspid
ni intracardiac clot/vegetation
no pericardial pathology seen
FINAL IMPRESSION-DCMP,Severe LV Dysfunction.LVEF=20-25%,DRA(Grade-III),Mild+MR.
my mother's age is 50 years.how dangerous is her condition?what diet should she follow?
doctor
Answered by Dr. Priyank Mody 8 hours later
Brief Answer:
Further tests and treatment needed.

Detailed Answer:
Hello, I am Dr Mody and I will be addressing your concern,
Firstly some information will help me guide you better .
Why did you get this test done,
Was she getting tired or breathlessness while she walks, any chest pain of heart beating fast. Is there swelling in the legs, what is her weight
What are her risk factors, is she hypertensive or diabetic
Is she on any medication.

Now I will enlist my recommendation
1)its not very serious, however it's not normal too, and I would recommend to see a cardiologist at the earliest as we don't want the heart pumping to go down further, normal pumping is around 60%, while her is exactly half
2) we need to find the cause of the decrease in pumping and treat it so we can give maximum chance for reversibility.
3) some tests will be required to further evaluate which I will suggest as soon as you upload the information asked and other test results whichever you have done like ecg, blood reports etc.
4) she needs to be out on medication for strengthing the heart, which should be started as soon as possible
5) for diet
Cut salt totally from diet, Daily intake less than 2 gms
Till we find the cause and reverse it, decrease water intake to less than 1200-1500 ml per day
Decrease the diet rich in oils, fats and high carbohydrate. Cut down on read meat, preserved food. If she takes fish 2-3 serving per week. Otherwise supplement like cod fish oil capsule 2 gms a day for omega 3 fatty acid.
If overweight, weight reduction is the key, if diabetic strict control of sugar.
Will wait for details from your side.
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Priyank Mody 1 hour later
SHE HAD DIFFICULTY IN BREATHING,SO WE TOOK HER TO HOSPITAL.
THERE EXCESS FLUID FROM HER BODY WAS TAKEN OUT.
SWELLING WAS IN HER LEGS BEFORE GOING TO THE HOSPITAL BUT NOT NOW.
SHE IS NOT DIABETIC BUT SHE HAD PROBLEM OF FLUCTUATING BP.
BLOOD REPORT:
HBSAG-NEGATIVE
TROPONIN-T/I :-NEGATIVE
BLOOD SUGAR-171mg/dl
CREATININE-1.3 mg/dl
SODIUM-142mmol/L
POTASSIUM-3 mmol/L
CK-MB -16 U/L
S.G.P.T. - 40 U/L


HEMATOLOGY
WBC : + 10.58m/mm^3
LYM. : - 12.7%
MON. : 5.2%
NEU. : + 80.1%
EO. : 1.2%
BA. : 0.8%
Lym# : - 1.34 m/mm^3
Mon# : 0.55 m/mm^3
Neu# : 8.48 m/mm^3
Eo# : 0.13 m/mm^3


RBC : 4.09 M/mm^3
MCV : 103.5 fl
Hct : 42.3%
MCH : 25.9 pg
MCHC : - 25.0 g/dl
RDW : 12.4

Hb : 10.6 g/dl

THR : 227m/mm^3
MPV : 10.3 fl
Pct : 0.23%
PDW : + 13.2


ECG REPORT :
HR :134 bpm
P :86 ms
PR :128 ms
QRS :90 ms
QT/QTc :310/464 ms
P/QRS/T :72/19/241
RV5/SV1 :2.824/2.706 mV


DIAGNOSIS INFORMATION:
Sinus Techycardia
Flattened T Wave(I,a VL)
Inverted T Wave (V6)
Slight ST Depression(V3,V5,V6)
Left ventricular hypertrophy.




Sir these are the reports.
Sir will these things have impact on her life longevity?
Can she live a normal life from now onwards with the help of medicines and proper diet?
If she takes medicines and diet properly from now onwards,then can the problem of difficulty in breathing happen again?
doctor
Answered by Dr. Priyank Mody 26 hours later
Brief Answer:
Continue medicine, find the cause of decreased pumping and treat it

Detailed Answer:
I went through all the reports, thank you for the same.

All normal except
1) potassium is lower - she must be on lasix or similar drugs which will decrease the potassium further, request you to get it corrected or re checked if very old.
2) hemoglobin more than 12.5 preffered, will have less load on the heart
3)the ecg heart rate high must be because of fluid overload, hopefully present heart rate should be normal.

Now with medication and strict diet she should be symptoms free for rest of the life, however the aim is to maintain the same quality of life, so I will again stress that you get the cause for decrease in the pumping and treat it so we can reverse maximum possible and get the back to as near as normal possible. Yes the breathing problem can come back if extra fluid accumulates again.

The best test to know the reversible defects is get a thallium perfusion scan, if it is normal or generalised. Than medication will be enough, if it shows decreased blood flow to any territory (because echo shows lad), than angiography and revascularisation should be the aim.

Do upload the medication too so if I think any change to further help her I can suggest.
Regards Dr Priyank Mody

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Priyank Mody 55 minutes later
Sir I have uploaded the images of the medication slip.the names of the medicines are not clear to me but I am writing what I am getting
Planep-T 10
Cardivas
Carda cl
Tonact Asp
Total 60
You can see the medication slip of the doctor in the uploaded report section.
sir please tell this one thing that if my mother takes proper medication and diet from now onwards,then can she live for more than 20 years from now or more than 15 years?sir please reply as doctors in XXXXXXX are saying that patients with heart failure(severe lv dysfunction) don't survive much and can't live a normal life from now?sir please reply...
doctor
Answered by Dr. Priyank Mody 15 minutes later
Brief Answer:
Continue medicine and evaluate further

Detailed Answer:
Hello, I will again stress on the point that cause should be found and treated so we can reverse the and bring pumping at around 40-45 %
The medication is good enough, however we should maximise the dose of cardivas and cardace both to maximum tolerable limits to provide maximum benefit. .
As your doctor has suggested an angiography is justified in the this setting.
Cardiology has progressed enough that we can offer your mother a good 15-20 years of life. However just medication diet and dua will not give maximum benefit, whatever is needed should be done as xray doesn't show dilated heart so, we can reverse the decrease in pumping
A thallium perfusion and angiography is what I will suggest as a cardiologist.
If finance is a problem, than medicine as prescribed and diet should be ok.
If just how much she would survive is the question you wish to ask, my numbers it's only 50% what survive more than 5 years with just diet.
Regards Dr Priyank Mody
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Priyank Mody 8 hours later
Sir my mother is getting weaker everyday.she is very weak right now.so by how many days can we delay angiography?as I told she is getting weaker everyday,what should we do to make her strong?
sir X-ray is not showing dilated heart but echo report says dilated lv.so can LVEF still increase?
If LVEF will not increase then can a patient survive with 20-25% LVEF for 20 years?
Sir another point in the echo report is dilated cardiomyopathy (dcm)(lv type).
What does this mean?
doctor
Answered by Dr. Priyank Mody 27 hours later
Brief Answer:
Do go through the detailed information

Detailed Answer:
Hello,
I would enlist my answers so that you can correlate well.

1) The weakness has two components. When the fluid was removed from the body, there is also loss of electrolytes giving her an acute sense of weakness. That is the the reason I asked her to get potassium levels measured and treated, 2nd component of the weakness is itself due to decreased pumping of heart so all muscles receive less blood. About 70% of weakness will resolve over time.

2) Echo is sensitive to know cause of dilation, however as X-ray is not showing it, it's means it's not very very severe and may be reversible.

3)With this condition she is living since 20 years is very rare, so miracles do happen in medicine. The most common cause is sudden cardiac death is such patients, so in USA and Europe if there is less than 30% pumping, a defibrillator is implanted to prevent such an episode along with medicines if the condition is not reversible.

4) lv stands for left ventricular, the chamber which pumps all the blood in the circulation, so that chamber which is more important is dilated in your mother, leading to all the symptoms.
Still according to me a thallium perfusion scan should be the next step, if it has diffusion defect angiography may be offered.
Hoping I could help.

As your mother needs constant monitoring and fine titration of medication. A monthly follow up with your doctor is advised.
Regards Dr Priyank Mody, Cardiologist, Lilavati Hospital, XXXXXXX
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Priyank Mody 27 hours later
Sir I have uploaded coronary angiography report.
What to do now.
1.Sir doctors in XXXXXXX are saying that your mother will not live much.Sir she is just 49 years old.What should I do to ensure her long life (atleast 20 more years)?
2.Can her LVEF ,which is currently 25%,increase?
3.what will be enough to avoid symptoms like high bp,excess fluid accumulation in future?
Sir please reply...
Thanks in advance...
doctor
Answered by Dr. Priyank Mody 1 hour later
Brief Answer:
Continue medication, lifestyle modifications to prevent symptoms.

Detailed Answer:
Hello,
The angiography being normal is bad in the context that except medical management we don't have much.
This would establish the diagnosis of non ischaemia idiopathic dilated cardiomyopathy
However as I say cardiology has evolved enough to give a good quality of life .
Two aspects here are management of symptoms and prevention of sudden cardiac death.
Now as I said according to XXXXXXX guidelines, your mother is a candidate for AIcD(it's a implantable cardioversion and defibrillator), which will provide a shock whenever the heart suddenly stops prevention sudden death. This is something new for you and you may need more info. So a discussion with your cardiologist will help, as on this written platform it will be difficult for me to explain.
Now for slowly building exercise tolerance, optimisation of medicine should help .
General precautions.
1) limit all liquids less than 1 litre
2) daily weight, make sure she maintains constant weight.
3) drugs included. Carvedilol, ace inhibitors /ARB group, diuretic - furosemide, eplerenone- planep, statin group
Supplement s that should be added.
Omega 3 acid(cod fish capsule) 1gm twice
Tab carnitine 500mg twice
Some multivitamin /mineral supplement.
I have had my patients living for more than 10-15 years if proper care taken
And most important when unexplained dilated cardiomyopathy is many times post viral myocarditis. Than there is a fair chance it will reverse.
Hoping I could help
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX
Any further assistance you may get my contact info from Health care magic.


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Priyank Mody 26 hours later
TAB LANOXIN 0.25 mg - 1 TAB DAILY FOR 5/7 DAYS
TAB CARDACE 2.5 mg -1 TAB DAILY
TAB TIDE-PLUS 10 mg -1 TAB DAILY
TAB IVABID 5 mg -1 TAB TWICE DAILY
TAB PANTOCID 40 mg -1 TAB DAILY 1/2 HOUR BEFORE BREAKFAST
TAB CARDIVAS 3.125 mg -1 TAB TWICE DAILY

ARE THESE MEDICINES GOOD ENOUGH?ARE THESE MEDICINES FOR INCREASING LVEF?
doctor
Answered by Dr. Priyank Mody 15 hours later
Brief Answer:
Yes the medication is optimum, yes they are for increasing LVEF over time

Detailed Answer:
Yes the medication prescribed is good and would help heart to regain strength and improve overall LVEF over time.
As I said adding omega 3 fatty acid , carnitine supplement should be added for whatever benefit after 1-2 month, presently increasing the pill burden seems un warranted.
Just add a multi vitamin like tab a to z to above regime as her appetite would have decreased a lot due to liver congestion.
Any help needed you can contact me on http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273
Wishing your mother a healthy life
Regards Dr Priyank Mody
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Priyank Mody 2 hours later
sir, can my mother eat sodium free salt?
doctor
Answered by Dr. Priyank Mody 7 minutes later
Brief Answer:
NO, Do go through the detailed answer for explanation

Detailed Answer:
Try avoiding, as most sodium free salts have potassium chloride. Now you are on two medication which increases potassium, cardace and plus component of tide, fluctuations in sodium is well tolerated while even 1 meq fluctuations in potassium are life treating particularly in your mother.
Ultimately everyone should take low salt diet, it would be difficult in the initial part but it's a necessity for her and trust me it becomes routine one you develop the taste.
Regards Dr Priyank Mody
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Priyank Mody 8 hours later
Sir my mother's age is 49 years,height = 148 cms , weight = 52 kg.
what exercise she should do and should she start doing exercise?how much exercise she should do now?
doctor
Answered by Dr. Priyank Mody 4 hours later
Brief Answer:
Exercise is a must for her overall well being

Detailed Answer:
There is a concept of cardiac rehabilitation. She can visit a good cardiac physiotherapist who would in the lab check her exercise tolerance and plan the exercise programme for her. Mostly it should be there in XXXXXXX and you may ask your cardiologist for the same.
She may start with walking and stretching exercise ad basic.
Regards Dr Priyank Mody
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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