Brief Answer:
A differential diagnosis necessary.

Detailed Answer:

Hello!

Thank you for asking on HCM!

I understand your concern, and would like to explain that to identify the right responsible cause of your complain, it is necessary to perform a differential diagnosis.

First of all, a comprehensive medical review of your actual cardio-vascular status should be done: careful physical examination to rule in/out clinical signs of systemic congestion coupled with a cardiac ultrasound, chest X ray study, and blood tests like NT-pro BNP would definitely clarify a possible adverse implication of heart failure on your current complains.

If clinical symptomatology of HF is present, especially pulmonary congestion, and cardiac ultrasound reveals abnormally increased left ventricular end-diastolic pressure (PCWP), increased PASP (pulmonary artery systolic pressure), in addition to decreased LVEF (left ventricular ejection fraction); also abnormally increased NT-pro BNP, then an adverse effect of acutely decompensated heart failure is highly possible.

In such case HF therapy modulation is necessary; a substantial reduction of Coreg dose and possibly stop (replacing for a safer alternative) is necessary (as beta-blockers are contraindicated in asthma); also a possible addition of diuretics should be reviewed by your attending cardiologist.

Other potenjtial etiological factors to consider are your pulmonary disease (asthma), as it may produce such a complain. You need to discuss with your attending allergist (pulmonologist) to review your current pulmonary function implication by asthma; and to review whether current therapy is appropriately stabilizing bronchial hyperreactivity. A pulmonary function test would be of help in this regard.

A visit to an ENT specialist to investigate the severity of post nasal drip syndrome (examine your para-nasal sinuses) is necessary to exclude the degree of its implication on your complains.

And at the end, a folow up visit to your hematologist to assure that your myelogenous leukemia hasn't showed any possible relapse (which could appear with broncho-pulmonary symptomatology as well).

Hope to have been helpful to you!

Feel free to ask me whenever you need! Greetings! Dr. Iliri

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Brief Answer:
You are welcome!

Detailed Answer:
I am glad to have been helpful!

You can ask me directly whenever you need and I will be happy to answer to all your uncertainties.

Best wishes,
Dr. Iliri

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