Suggest Treatment For Right Ventricle Heart Failure In A Hypertensive Person
there is a leak in her bicuspid valve with regurgitation in an advanced stage is there hope
Medical therapy is effectve to improve his symptoms...
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
Based on the data you provided It seems that your loved one is suffering from cor pulmonale. Cor pulmonale is associated with right ventricle heart failure and pulmonary hypertension.
Cor pulmonale doesn't need surgery but it may be treated with medicine (pills). Medical therapy is effectve to improve his symptoms (and life quality). Unfortunately cor pulmonale can't be completely healed.
If he was my patients I would recommend to use the following treatment to relieve his symptoms:
- Beta blockers
- Anti coagulation (qumadin)
- Diuretics
- Sildenafil (viagra)
- Prostacyclin
However It's essential to check all his examinations in order to determine the right doses for him.
Can you please upload all his data for me?
Wish you and your loved one all the best!
Dr. Shehu
the assessment was Assessment:
· Pulmonary htn/R heart failure due to underlying lung disease
· Severe TR per echo on 3/1
· Chronic diastolic HF (EF 60-65%) per echo on 3/1
· B/L pleural effusions
· Chronic hypercapnic respiratory failure
· COPD / emphysema as seen on CT scan - not wheezingAcute metabolic encephalopathy-better
· Recent right pneumothorax at outside hospital - no PTX now
· Coffee ground emesis
· Paroxysmal A fib on Coumadin with coagulopathy now
· Chronic foley for unknown reasons (replaced in ED). Says recently placed at Ingals
· On steroids (?chronically?)
· Anemia
· Protein calorie malnutrition the diagnosis was MD CONCLUSIONS
The left ventricular chamber size is decreased.
There is normal left ventricular systolic function.
The ejection fraction is 60-65%.
The right ventricular cavity size is severely enlarged.
The right ventricular global systolic function is normal.
Flattened in systole and diastole consistent with right ventricular
pressure and volume overload.
The right atrial cavity size is severely dilated.
There is malcoaptation of the tricuspid leaflets due to RV dilation
There is severe tricuspid regurgitation.
The right ventricular systolic pressure is estimated to be 35-40 mmHg.
A trivial pericardial effusion is visualized.
A left pleural effusion is present.
The inferior vena cava appears dilated in size. the difficulty is with the pulmonary hypertention it is extreme along with other issue like the tricuspid valve between the right atrium and ventrical being quite damaged. there is blood back flow and enlargement of both right chambers tremendous pressure and edema in lower abdomen along with fluid from pleural effusions in chest cavity although it seems to be under control. I am fighting for a second opinion but running out of time. she was made to feel as if the hospice was her only choice to go and die. I know the medical prognosis is grim but, I really feel all measures were not explored since she is a Medicaid patient. please advise
Following advice
Detailed Answer:
Hi back,
The data you provided are suggestive for chronic cor pulmonale which is a complication of COPD.
In order to improve her symptoms and the quality of life I would recommend to properly treat COPD by a pulmonologist and to properly treat cor pulmonale.
I would recommend to use the following medications:
- Diuretics (furosemid and spironalacton to improve symptoms related to pulmonary hypertension
- Sildenafil 100mg 2 tablets per day (morning and evening)
- Prostacyclin (epoprostenolol) is effective on reducing pulmonary hypertension and it improve symptoms and quality of life.
You should contact once again her doctor and discuss with him. If he refuse to do so ask for a second apecialist.
Wish you and your family health!
Dr. Shehu