diastolic dysfunction

hello doctor,my grand mother 72yrs old is a known hypertensive for 10 years,she is also suffering from subclinical hypothyroidism , diabetes & osteoarthritis.she is on regular medication of: losartan-h 50mg , atenolol , thyronorm , aspirin 75mg , atorvastatin 10mg , evion , dytor 20mg all on OD doses. she has to take nimuselide BD dose because of pain.she has ISOLATED SYSTOLIC HYPERTENSION usually s.b.p shoots upto 160-180mmhg. otherwise it remains between 130-140/60-50mmhg.diabetes is under diet control ,it has been diagnosed 5yrs back may be it is drug induced coz of beta blockers and diuretics.from last 3yrs she is having dyspnoea on exertion which now has increased to the extent that she cant walk more than 6 to 7 steps at a time ,complains of pain in epigastrium which subsides on rest  & diaphoreses .there is NO orthopnea or pnd .blood tests are normal. ECG has lvh .on ECHO : there is diastolic dysfunction , lvef :54% , no rwm abnormality or  valvular ds. ANGIOGRAPHY :RCA 40% BLOCK ,LCA NORMAL. KINDLY advise for dyspnoea & some safest analgesic.i shall be thankfull.

[dr_simran]

Hello amitnanni,
It seems that the dyspnoea is due to increased cardiac congestion with symptoms of congestive cardiac failure. Avoid rosiglitazone and pioglitazone for the management of diabetes. Take painkiller like ibuprofen for the management of pain and consult a cardiologist for the dosage modulation of the CCF drugs.
Best