Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

Regarding your concern, I would like to explain that your recent complaint (profound sweating while performing even mild activity is considered a nonspecific sign potentially due to several causes.

In your clinical conditions the most likely reason for such a phenomenon could be considered hypoxemia and low cardiac output.

Nevertheless, other potential reasons may be implicated as well.

In order to be possible for me giving a more precise professional opinion, I would like to directly review your cardiac ultrasound report and other available medical tests as well.

In addition, it is very important revealing the primary reason of your cardiac dysfunction (stage II diastolic dysfunction and potentially systolic dysfunction as well).

Is is from an ischemic cardiac disorder or a cardiac involvement due to a systemic disease?

Also, some other tests would be necessary for a better judgement of the situation:

- complete blood count,
- thyroid hormones level,
- arterial blood gas analysis,
- blood electrolytes level,
- fasting blood glucose and HbA1C,
- cardio-pulmonary exercise stress test (measuring peak VO2, etc.)

I remain as your disposal for reviewing your medical tests and a detailed medical history.

Kind regards,

Dr. Iliri
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Brief Answer:
My opinion as follows:

Detailed Answer:
Hi again, dear Christine!

I carefully reviewed your uploaded cardiac ultrasound report and would explain that you have a mild left ventricular diastolic dysfunction, but your cardiac systolic function is quite normal.

As e result of impaired LV relaxation (diastolic dysfunction), increased left ventricular end - diastolic pressure is generated (E/E’ 16) and subsequently this is reflected with backward elevation of pulmonary venous pressure and mildly elevated pulmonary artery pressure (35 mmHg).

The long - standing hypertension seems to be the major reason for this diastolic dysfunction and its adverse consequences.

The best strategy to stop and possibly reverse these changes would be an optimal control of your blood pressure values.

Coming to this point, it is necessary to closely control you BP values (several times daily for a couple of days up to a week) and let your attending doctor review them.

This would be a rationale clue in optimizing your ongoing anti-hypertensive therapy.

Meanwhile, besides the above mentioned medical tests, I would also recommend performing a cardiac stress ECHO in order to explore the potential further increase of LV end - diastolic pressure and pulmonary artery pressure.

This would be an optimal way of beginning to explain potential reasons of excessive sweating.

In addition, an alternative therapeutic scheme would be necessary to substitute for your actual combination Toprol 200 mg/day and Verapamil 180 mg/day which may be a source of early fatigue during activity and sweating too.

You need to discuss with your attending physician on the above mentioned issues.

Hope to have been helpful to you!

Regards,

Dr. Iliri

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