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Suggest Treatment For Pulmonary Histoplasmosis

Posted on Mon, 3 Jul 2017

Question: Hi. I am 35, female and diagnosed with pulmonary histoplasmosis in December 2016, then fibrosing mediastinitis in May 2017, and most recently, possible heart failure. I've had uncontrolled blood pressure for a long time. I am on metoprolol and lisinopril with Lasix for swelling in my legs and feet, and itraconazale. I am also taking prednisone 30mg a day which is being titred down until I return to the Mayo clinic on 6/30 for a collapsed lung and inflammation from the FM diagnosis. Recently, the swelling has become worse and not improving with Lasix. My blood pressures are 150/100's regulary and I am having chest pains and headaches. My PCP did and EKG that showed "structural damage or changes" compared to the normal EKG I had done in Feb 2017. I had an echo done and am awaiting the results. I also had an elevated BNP level of 135 and some high kidney function levels. Does this sound like I will be getting a diagnosis of heart failure?

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that your symptoms (increased swelling) coupled with the increased BNP levels go in favor of heart failure.

The inflammation of the heart muscle may be the cause of this clinical scenario.

But it is important to evaluate the heart function in order to come into more professional conclusions.

The kidney dysfunction can also trigger this clinical scenario (leg swelling).

I would like to directly review your cardiac ultrasound report for a more professional opinion if you can upload it.

Let me know about everything!

Kind regards,

Dr. Iliri

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

Follow up: Dr. Ilir Sharka (13 minutes later)

I appreciate your fast response and as soon as I have the results of the echo I will share them with you. I really just want as many opinions as possible. In your medical career, what is my prognosis or what should I comfortably expect with a heart failure diagnosis in my life now on top of FM and histo?

Answered by Dr. Ilir Sharka (15 minutes later)

Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I can not judge without having a look to you cardiac ultrasound.

But, you should know that life expectancy in heart failure patients is different in different individuals. It depends on individual characteristics.

It is important to have an optimal therapy and a close follow up with the cardiologist.

But, I would recommend avoiding suppositions and wait for the test results.

I remain at your disposal for any other questions!

Kind regards!

Dr. Iliri

Note: For further queries related to coronary artery disease and prevention, click here.

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