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Had Coronary Vasospasm And High Blood Pressure After Pregnancy. What Treatment Should Be Done?

Posted on Thu, 19 Jul 2012

Question: I am a 32 year old female. Married for seven years I have 2 kids aged 6 and 3. No abortions. I had used CU-T to space my kids. I attained menarche by the age of 13 years. Both my kids were born by LSCS indication being CPD and PIH. My younger son was born in march 2009 subsequently after my caeserian with tubectomy my Blood Pressure began to rise and I had an episode of coronary vasospasm. Which was treated. I had got a coronary angiography done in 2009 april which was normal. I was placed on diltiazem aspirin low dose but was removed after six months. For the last 3 years after this caeserian I have heavy periods. Up to 16 large pads per cycle. But the periods are regular. It was diagnosed as dysfunctional uterine bleeding.I was using mefenamic acid 500mg twice a day for the first 3 days of my periods. I am regulary using hematinics but couldn’t use for past two months. I travelled a lot last month and I noticed some swelling over my feet. I met my cardiologist a 2D Echo cardiography was done which was normal with an ejection fraction of 63%. A pap smear was done which was normal. Ultrasonography shows slightly bulky uterus which my gynaec said is normal for a parous woman. At the age of 23 I had one episode of CRVO left eye. My cardiologist told me to consult a gynaecologist and get treated as anemia could be bad for me. Please tell me what treatment options I have. Is merina safe for me? If it isn’t what are the options I have? last hemoglobin check was done in feb 2012 which was 12 gm% after which i stopped hematinics. my platelet counts are normal (2.4 lacs per cumm)

Answered by Dr. Dr. Rakhi Tayal (4 hours later)

Hello,
Thanks for posting your query.
Since your hemoglobin levels are normal, anemia and cardiac complications are not a worry for you.
Dysfunctional uterine bleeding may cause altered gonadotrophin secretion hence changed secretion of FSH and LH and hence changes in estrogen and progesterone levels.

Such changes result in
1. menorrhagia (abnormally heavy and prolonged menstrual period at regular intervals) or
2. metrorrhagia (uterine bleeding at irregular intervals, particularly between the expected menstrual periods).

Mid-cycle bleeding may indicate a transient estrogen decline, while late-cycle bleeding may indicate progesterone deficiency.

Laboratory assessment of hemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T4, thyroid stimulating hormone (TSH), and androgen profile can be done.

The management of this condition would require treatment with progesterone to stabilize the endometrium and reduce bleeding. Oral contraceptive pills (OCPs) suppress endometrial development, reestablish predictable bleeding patterns, decrease menstrual flow, and lower the risk of proper therapy.

Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (4 hours later)

my Tsh levels are normal. i have consulted 2 to 3 gynaecologists who have suggested DUB as the diagnosis and have suggested mirena or hysterectomy. all the preliminary tests have been done. i specifically want to ask you whether mirena affects a patient with a previous cardiac history (who is now stable)? how does hysterectomy effect the life of a patient with previous one episode of coronary vasospasm. i want to specify one thing i am a qualified medical general physician but i dont have gynaec experience.
your answer would be valuable for me to decide treatment options available.

Answered by Dr. Dr. Rakhi Tayal (7 hours later)

Hello.
Thanks for writing again.
Since you are bleeding heavily, it seems that hysterectomy is a better option for you rather than mirena coil. Mirena coil itself is associated with an irregular spotting or an increase in bleeding in some cases.
Mirena coil as such does not affect a patient with cardiac problems. Hysterectomy carries all the risks any major surgery has in a patient of coronary vasospasm. Although the surgery is done under spinal anaesthesia, chances of per op cardiac complications are present.
After the surgery, you may lead a normal life without any long term complications.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (6 hours later)

one last question madam if i undergo hysterectomy which would be better total abdominal or vaginal or laparoscopic. i have very little support at home to look after my kids. taking my medical condition into consideration is it better to go for laparoscopic hysterectomy. how many days of rest would be required after hysterectomy?
regards

Answered by Dr. Dr. Rakhi Tayal (7 minutes later)

Hello.
Laparoscopic hyterectomy will be the best option out of the three considering the minimal indoor stay and earlier recovery.
After a laparoscopic procedure, fifteen days of rest from any heavy and stressful activity will be adequate for a complete recovery.
All the best.
Take care.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (12 hours later)

hi dr XXXXXXX sorry to disturb you again. today i visited a gynaecology professor at my place she heard my entire history and told me to start with regesterone from 5th day of periods till 21st day and stop followed by pause tablet for three days. i have to follow this regimen for three months and i may not require a hysterectomy. she also told me regesterone has no cardiovascular side effects and i can take it safely.what do you say. she asked me the endometrial thickness in my last tvs which was 12mm scan was done in the month of march 2012. please reply can i follow this treatment safely given my previous history.
regards'

Answered by Dr. Dr. Rakhi Tayal (3 hours later)

Hello.
Taking regesterone for 21 days for three cycles may help in regularising your periods. It is not likely to cause any cardiac complications. This hormonal treatment (progesterone) is the first line of treatment for dysfunctional uterine bleeding. In case this helps in decreasing the bleeding then the surgery may be avoided.
An endometrial thickness of 12mm is just average and hormonal treatment might be of help.
You must give it a try.
Wishing you a trouble free early recovery.
Regards.

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar