Brief Answer:
All symptoms are due to congestive cardiac failure!

Detailed Answer:
Hi ,
Firstly thanks for choosing health care magic for your query!
Have noted all your details,Your husband is having Congestive cardiac failure,As a result of three myocardial infarction a large part of his heart is not functioning properly.
The role of heart is to pump purified blood recieved from lungs to various parts of the body,but due to ischemia and degeneration of cardiac muscles,The pumping function of the heart are greatly reduced and blood starts to flow back and accumulate in lungs and other spaces of the body like ankles ,pleura etc.As blood supply to various organs is curtailed Fatigue,letharg,Malaise,drowsiness,sleepiness appears.
Shotness of breath is also because of accumlation of fluid in lungs due to back flow from heart.As space to be occupied by air is taken by regurgitant fluid breathlessness occurs.

Under normal circumstances, the treatment of congestive heart failure includes medicine to strengthen the heartbeat, diuretic therapy to reduce fluid volume, and the use of a variety of other medicines to enhance heart function.Medical therapy with cardioselective beta blockers like carvedilol and bisoprolol allong with ace inhibitor ,nitrates and diuretics are usually very effective .However,In some of these patients even this is not enough.

If significant electrical system disease like left bundle branch block or a conduction delay in heart is observed pacemaker therapy seems to be quite useful,Pacemaker will prevent sudden cardiac arrest due to any arryhtmia arising as a result of congestive cardiac failure,though some trial shows that it improves cardiac function in long term,Yet results vary from one person to other.Main function of pacemaker is to prevent cardiac arrest from arrythmia.Please mention if your husband has biventricular or univentricular pacemaker(attach reports).

Your patient is having severe hypertension ,Blood pressure control is must for improvement of cardiac functions!
Kindly attach copies of his 2d echo and treatment which he is taking ,so that suggestion can be given in regards to medicines.

Infection would be treated by antibiotics TLC and DLC should be done on daily basis to monitor infection.

Please attach detailed copies of all his treatment papers,Medications and investigations!
Waiting!

Thanks
Dr Rishu Saxena

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Brief Answer:
Detalis below!

Detailed Answer:
Hi again,
2d echo reports are very important when we are dealing with a patient of congestive cardiac failure,However i can give suggestions on the basis of medications you have written down(again have not mentioned the doses).

A nitrate should be added to his regimn-
Nitrates dilate veins throughout the body so that they can hold more blood. This reduces the amount of blood going back to the heart, reducing the heart's workload.They are very strong venodialtor and can be used in resistant hypertyension to relieve the symptoms of congestive cardiac failure.
Long acting nitates like isosorbide mononitrate should be added in high dose 60mg every day.
This can be very helpful in lowering his blood pressure and relieving his symptoms.

Trimetazidine -Trimetazidine should be added in doses of 35mg twice daily.It is a cytoprotective anti-ischemic agent.
Trials done by NCBI shows- "short-term TMZ improved left ventricular systolic function and functional capacity despite no change in myocardial perfusion. These benefits were more evident in patients with more severe perfusion defects on initial evaluation.",Ask your cardiologiost to add trimetazidine in above mentioned doses.

Thirdly your husband is not prescribed any betablockers by your cardiologist, After 3 myocardial infarctions ,Beta blockers are a must and should be administered.Cardioselective betablockers like Metoprolol,Carvedilol,or bisoprolol should be added in optimal dosage.

Zircol and zinadip are both same salt calcium channel blockers,though they are used to treat hypertension,but they don't improve cardiac functions significantly.Ask your doctor to start high doses of betablockers and stop calcium channel blockers if required.

Thank you!

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Brief Answer:
Welcome!

Detailed Answer:
Your welcome!
Please do write a review.
Wish your husband a very happy recovery.

Regards,
Dr Rishu

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