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Heart Disease (Expert Forum)
What is my next step.
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What is my next step.
by HJ, May 10, 2003 12:00AM
I am a 71-year-old with a history of hypertension and COPD and now diagnosed with hypertropic cardiomyopathy. I had a syncopal episode in December. My echocardiogram showed septal hypertrophy at 17 mm with a hyperdynamic ventricle with an EF of 75%, with accelerated outflow track velocity outflow of 2 metersper second, corre;ating to a mean gradient of 10 mmHg. There is mild systolic anterior motion of the mitral valve. There was no pericardial effusion. My end-diastolic dimension was 45 mm. My left atrial size was 45 mm.I had a positive tilt table test.
The 24-hour Holter monitor showed runs of monomorphic ventricular tachycardia. A preliminary electrophysiologic study was done which showed no inducible, monomorphic VT, polymorphic VT, or VF with programmed stimulation, nor could the Doctor induce any automatic VT with burst pacing.
My previous medication (Hytrin and a diuretic) was changed to Lopressor, 100 mg twice a day and lisinopril, 40 mg once a aday.
I remain hypertensive with blood pressures ranges from 180-205 over 120-140. The change in medication inproved the periodic dizziness and episodes of flushing and near syncope. However, I am still dyspneic on exertion This is worse after eating. DOCTOR SAYS MY dyspnea may, in fact, be multifactorial, including COPD and obesity.
QUESTION: I am concerned over my high blood pressure and my short and my shortness of breath. Are these a result of hypertropic cardiomyopathy? Should I be seeing another cardiologist with an eye to surgery? If not, what is my next step.
The 24-hour Holter monitor showed runs of monomorphic ventricular tachycardia. A preliminary electrophysiologic study was done which showed no inducible, monomorphic VT, polymorphic VT, or VF with programmed stimulation, nor could the Doctor induce any automatic VT with burst pacing.
My previous medication (Hytrin and a diuretic) was changed to Lopressor, 100 mg twice a day and lisinopril, 40 mg once a aday.
I remain hypertensive with blood pressures ranges from 180-205 over 120-140. The change in medication inproved the periodic dizziness and episodes of flushing and near syncope. However, I am still dyspneic on exertion This is worse after eating. DOCTOR SAYS MY dyspnea may, in fact, be multifactorial, including COPD and obesity.
QUESTION: I am concerned over my high blood pressure and my short and my shortness of breath. Are these a result of hypertropic cardiomyopathy? Should I be seeing another cardiologist with an eye to surgery? If not, what is my next step.
Doctor's Answer
by CCF-M.D.-KE, May 12, 2003 12:00AM
Dear HJ,
Sorry to hear about your medical conditions. You have a complicated case which deserves more attention than I can give in this forum, however I will make some comments.
First, your blood pressure needs to be aggressively managed. The readings you have listed are unacceptable.
You have also stated that you have systolic anterior motion(SAM) of the mitral valve with a mean gradient of 10mm Hg. Did the sonographers try to provoke a higher gradient?
The condition you describe is serious and I would recommend being evaluated at a large university based medical center.
The Cleveland Clinic has experts in this area, you can learn more at our website www.ccf.org or call for an appointment at 1-800-CCF-CARE (Dr. Lever).
If you decide not to seek care here, please see an expert at another center. I hope you feel better.
Thanks for your question,
CCF-MD-KE
Sorry to hear about your medical conditions. You have a complicated case which deserves more attention than I can give in this forum, however I will make some comments.
First, your blood pressure needs to be aggressively managed. The readings you have listed are unacceptable.
You have also stated that you have systolic anterior motion(SAM) of the mitral valve with a mean gradient of 10mm Hg. Did the sonographers try to provoke a higher gradient?
The condition you describe is serious and I would recommend being evaluated at a large university based medical center.
The Cleveland Clinic has experts in this area, you can learn more at our website www.ccf.org or call for an appointment at 1-800-CCF-CARE (Dr. Lever).
If you decide not to seek care here, please see an expert at another center. I hope you feel better.
Thanks for your question,
CCF-MD-KE
