Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Moderate LVSD
Question: Hi doctor,
My mother is been indentified with moderate lv systolic disfunction. It is identified after 2d echo test today. Doctor we are consulting gave some medicines. Atorfit CV 10mg, Telma 40MG, Dytor Plus 10MG & Cardivas CR 10. Doc asked my mother to use these medicines for 2 weeks n we need to go for the same investigations ecg and 2d echo might be along with angiogram.
Am nt trying to insult anyone but want an oinion from you sir.
Please suggest us the way.
My mother is been indentified with moderate lv systolic disfunction. It is identified after 2d echo test today. Doctor we are consulting gave some medicines. Atorfit CV 10mg, Telma 40MG, Dytor Plus 10MG & Cardivas CR 10. Doc asked my mother to use these medicines for 2 weeks n we need to go for the same investigations ecg and 2d echo might be along with angiogram.
Am nt trying to insult anyone but want an oinion from you sir.
Please suggest us the way.
Brief Answer:
Continue meds, monitor as advised, and try finding and corecting the cau
Detailed Answer:
Hello, went through your history, if possible do send the ecg and echo report.
Now what were the symptoms which compelled you to seek medical advice, was it chest heaviness Or breathlessness or easily getting fatigued or just routine evaluation
What are her Co morbid condition. Diabetic /hypertensive
By convention moderate systolic function is between 35-40% ejection fraction
. The medication your doctor prescribed are all justified, as they all protect the heart against further deterioration and strengthen it. What is important is titration as starting them all at once we would not know how her body would react. Keep checking the blood pressure, pulse and urine outpuy and visit your doctor for titration or follow up with me.
About angiography, it's important to identify the cause and treat the same for good long term results. Seeing ecg and echo will help be better guide when to go for
Repeating echo after 2 weeks is not justified as it's not going to change much. However you should do S.Creatinine, S. electrolytes to know how they behave with all the meds and I strong suggest you to do them.
Apart from that, temporary fluid restriction less than 1200ml day, cutting salt in diet may help.
Simultaneously workup for diabetes detection, thyroid, lipid profile and baseline blood tests should be done if not already
Regards Dr. Priyank Mody
Continue meds, monitor as advised, and try finding and corecting the cau
Detailed Answer:
Hello, went through your history, if possible do send the ecg and echo report.
Now what were the symptoms which compelled you to seek medical advice, was it chest heaviness Or breathlessness or easily getting fatigued or just routine evaluation
What are her Co morbid condition. Diabetic /hypertensive
By convention moderate systolic function is between 35-40% ejection fraction
. The medication your doctor prescribed are all justified, as they all protect the heart against further deterioration and strengthen it. What is important is titration as starting them all at once we would not know how her body would react. Keep checking the blood pressure, pulse and urine outpuy and visit your doctor for titration or follow up with me.
About angiography, it's important to identify the cause and treat the same for good long term results. Seeing ecg and echo will help be better guide when to go for
Repeating echo after 2 weeks is not justified as it's not going to change much. However you should do S.Creatinine, S. electrolytes to know how they behave with all the meds and I strong suggest you to do them.
Apart from that, temporary fluid restriction less than 1200ml day, cutting salt in diet may help.
Simultaneously workup for diabetes detection, thyroid, lipid profile and baseline blood tests should be done if not already
Regards Dr. Priyank Mody
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi Sir,
She is diabetic since 5 years. And the current problem is identified when we went for a general evaluation. She never has pain or breathelessness.
Attached the reports with this. Please help us with the further steps.
She is diabetic since 5 years. And the current problem is identified when we went for a general evaluation. She never has pain or breathelessness.
Attached the reports with this. Please help us with the further steps.
Brief Answer:
She should undergo furthur investigation as described Below
Detailed Answer:
Hello , i did go through the reports . thank you for sending .
ECG - the pattern described is not normal and may suggest old heart problem , however as you describe if she are no symptoms no acute treatment needed for the same .
ECHO - as you said the pumping of heart has gone down , the reason we need to know . a particular pattern here is that overall all the walls of heart are moving less , it is not any particular segment , so there can be two possibilities here .
1) blockage in the arteries which supplies the heart
2) what we call microvascular disease . here all the arteries are normal , but in diabetes , very small vessels which are in the heart muscle has degenerated .
so how do we know what the problem is ?
One is coronary angiogram - if you decide for it , than go for routine conventional coronary angiography and not CT coronary angio.
The second way and my preffered here will be to go for something called .
PERFUSION SCAN , thallium scan . its non invasive test where it is checked if the blood supply to all parts of heart is normal or not . if normal only medication is required and the pumping of heart should improve with time , if it is abnormal , than it is justified to go ahead with angiography with revascularisation as needed .
The above recommendation is based on XXXXXXX and european guidelines ,2014.
Now the question , why she did not have smptoms all the time ?
In diabetic patients this is very commonly seen that they may suffer from minor heart attacks without symptoms , which ultimately weakens the heart . nothing to worry in this context .
So , finally continue with the medications prescribed , restrict salt in diet , strict control of diabetes and close monitoring of parameters i had previously described.
i will suggest atleast 3 monthly follow up with the doctors , will all investigation so he may monitor and titrate the medicine dose .
Any further assistance is needed do let me know
Regards Dr, Priyank Mody , Lilavati Hospital XXXXXXX
She should undergo furthur investigation as described Below
Detailed Answer:
Hello , i did go through the reports . thank you for sending .
ECG - the pattern described is not normal and may suggest old heart problem , however as you describe if she are no symptoms no acute treatment needed for the same .
ECHO - as you said the pumping of heart has gone down , the reason we need to know . a particular pattern here is that overall all the walls of heart are moving less , it is not any particular segment , so there can be two possibilities here .
1) blockage in the arteries which supplies the heart
2) what we call microvascular disease . here all the arteries are normal , but in diabetes , very small vessels which are in the heart muscle has degenerated .
so how do we know what the problem is ?
One is coronary angiogram - if you decide for it , than go for routine conventional coronary angiography and not CT coronary angio.
The second way and my preffered here will be to go for something called .
PERFUSION SCAN , thallium scan . its non invasive test where it is checked if the blood supply to all parts of heart is normal or not . if normal only medication is required and the pumping of heart should improve with time , if it is abnormal , than it is justified to go ahead with angiography with revascularisation as needed .
The above recommendation is based on XXXXXXX and european guidelines ,2014.
Now the question , why she did not have smptoms all the time ?
In diabetic patients this is very commonly seen that they may suffer from minor heart attacks without symptoms , which ultimately weakens the heart . nothing to worry in this context .
So , finally continue with the medications prescribed , restrict salt in diet , strict control of diabetes and close monitoring of parameters i had previously described.
i will suggest atleast 3 monthly follow up with the doctors , will all investigation so he may monitor and titrate the medicine dose .
Any further assistance is needed do let me know
Regards Dr, Priyank Mody , Lilavati Hospital XXXXXXX
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi Doc,
Thank you so much. We will follow everything as instructed. Please tell that nothing is serious and we will follow evrything as u doctors say.
Thanks sir.
Thank you so much. We will follow everything as instructed. Please tell that nothing is serious and we will follow evrything as u doctors say.
Thanks sir.
Brief Answer:
Be reassured, but be vigilant
Detailed Answer:
She is all fine, only consideration is that she should continue medicines . Even with this pumping if medication are taken properly she will have no problem, even if she wants to go for a marathon, I hope that will be reassuring.
The only reason sir, why to investigate is to find the cause, treat it and it gives us objective evidence for treatment Where we can monitor how much the treatment is helping
Do send further investigation and follow up so I can be part of the treatment for your dear mother
Regards Dr. Priyank Mody
Be reassured, but be vigilant
Detailed Answer:
She is all fine, only consideration is that she should continue medicines . Even with this pumping if medication are taken properly she will have no problem, even if she wants to go for a marathon, I hope that will be reassuring.
The only reason sir, why to investigate is to find the cause, treat it and it gives us objective evidence for treatment Where we can monitor how much the treatment is helping
Do send further investigation and follow up so I can be part of the treatment for your dear mother
Regards Dr. Priyank Mody
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
