Angina pectoris

[lessemoja]

En serbisk venn har sendt meg dette brevet. Svar ønskes på engelsk.

This time, when my father is ill, I need help - for

him. I am going to explain his illness in a few steps

and some suggestions of how you could help.

1. His name is D.D. born 1932.

2. Here is the cardiolog's report about the illness.

Miocardiopath chr. ish. dil. NYHA III

Insuff. Val. mitralis

Angina pectoris

3. Ultrasonic test shows the follwing:

Left chamber (of the heart - I don't know exact

medical name) - VS: systolic diameter: found 7.2 cm

(normal: 3.7-5.6); diastolic: found 5.6 cm (normal:

4.1);

Septum thickness - found: 7.9 cm (normal: 0.7-1.1),

Back wall thickness - found: 7.9 cm (normal: 0.7-1.1);

Left sub-chamber (of the heart - I don't know exact

medical name) - AS: dimension: found 4.8 (normal:

2.0-4.0)

Aorta - AO: dimension: 3.9 (normal: 2.1-3.7)

In other words, the left sub-chamber is enlarged,

walls worn out, septum of changed motion, global

contractibility reduced.

4. Symptoms. (a) He feels pressure and pain in the

chest. I understand it as the heart doesn't pump all

the blood into the body, but part of it goes back to

the lungs, which causes the pressure. To relieve that

pressure and pain he takes a diuretic (Lasix), which

is an indirect method. ( He cannot lie down

horizontally in the bed, but he must sleep by sitting.

This is terrible. Because of that he is tired and

exhausted. © He is probably developing cardiac

asthma. He needs fresh air when we feel it fresh

enough. (d) His heart bits with breaks (arythmia). (e)

The heart biting is irregular. Sometimes it is too

fast, sometimes too slow. (f) The blood pressure looks

"normal" (80 - 115), but this is too low when he takes

medicine, which mostly reduce it.

5. The biggest problem is that the doctor and we all

cannot find the right medicine. My father's

state is getting worse every day. We have mentioned

the possibility for operation to the doctor, but he

said my father is too old for such operation. I don't

believe that. Unfortunately, the only place where they

do the heart operation is in Belgrade. It might be

possible, if I can find good connection and money.

6. Here is the medicine he was subscribed: Dilacor

(content: digoksin), Dilcoran 80 pentaeritritil

tetranitrat), Minsetil (meksiletin hlorid), Monizol

(isosobid-mononitrat), Prilenap (enlapril), Presolol

(metoprolol tartarat), Dilatrend (karvedilol),

Enalapril (enalapril-maleat), Amiodaron (amiodaron).

As I mentioned, none of them was evidently successful.

Some of them reduce the blood pressure too much.

How you can help. You can ask your doctor (or

cardiolog) to recommend another medicine. What does he

think about the possibility of operation?

[Einar Søyland, spesialist i hjertesykdommer]

Answer to Lessemoja.

It is impossible for me to give you an exact diagnosis and plan for future treatment based on the information in your letter. Let me try to review my opinion on what I suppose is correct concerning his symptoms and medication :

A man of 71 with these symptoms usually has an advanced coronary artery disease, possibly already complicated by previous myocardial infarction (s), mitral regurgitation (valvular leakage between left atrium and ventricle) and a heart pump failure. He is not too old for an operation or other invasive treatment for his coronary disease, although the possibility for an operation is dependent on the general physical condition and previous myocardial damage.

His medication is hopefully not correct as stated, because this would be dangerous for him. A combination like the one you write would give him very serious side-effects, and also reactions between the drugs. A usually prescribed combination in our country and the U.S. would be Monizol, enalapril and Presolol (or Dilatrend), mostly combined with an anti-thrombotic agent. The rest of his medication should be reconsidered and possibly discontinued.

This patient should, without further delay, be cardiologically examined and considered for invasive therapy (as soon as possible).