a cardiac case .. what to advise him ?

[dr_amro]

Hi doctors ,,

that is a case on the own words of a cardiac patient
I think it is a nice case ,,, to deal with

i get it for u to listen to ur advices to that patient and to answer his Qs ...

read carefully ...

waiting for ur answers and disscussion


----------------------

case ..

Hi had a heart murmur diagnosed when i was 21 ,had this all checked out at a specialist hospital ecg,echo, xray and the finally a consultant who diagnosed an innocent mvp. i am now 45 been to the doctors because i was feeing tired and had poundings in my chest when in bed , he checked my blood pressure which was high 159/90 he then llstened to my chest and said the murmur was very loud but not to worry but he did seem very surprised at the loudness and checked back through my notes quickly!! he refered me back to hospital i see a junior doctor my blood pressure was sky high 206/? i had blood tests ecg and eyes checked and blood cultures and thjunior doctor said the murmur sounded typical of what she listened to in training i was then sent home ,and had follow up as an outpatient , i have so far had a 24 hour tape ecg and seen a specialist today for my results he said the ecg showed and insignifacant palpitaytion cant remember the correct term (think it was something like vetrical...also blood pressure was 160/ 83 and he then listened to my murmur and then got a registrar to listen and said it was to loud for a normal mitral valve prolapse there was a lot of eye contact going on between the registrar and the one i went to see .i have now got to have an echo. what does this all mean? could my high blood pressure cause the murmur to be louder or is the mvp causing high blood pressure as always i think of all the questions after i have left the specialist can it still be innocent murmur or has something changed . i have also got to see my gp for control of blood pressure this all started back in june
this year thanks for any advice

[salammasri]

nice case doc
I will try

I will say to that patient the following

dont worry your murmers are that of mitral valve prolapse
for that you need to do some mild execise that may benifet your heart
you also should take some drugs as (b blocker) for your anxiety hepertension and it also incease force of your heart
your gp will adjsut the dose according to your respone
also you should take blood thinning element as prophylaxis or it better to use alow dose aspirin

donot worry
your hypertension is mostly essential and is not as aresult of yor heart problem

the doctor asked for echo
it is normal follow up procedure
to role if there is any infection ( but it is not possible in your case) or mitral regurge
which is more possilble
but donot worry the louder the sound of your murmer the milder the regurge

[dr_amro]

good advice dr salam ..

but why you consider the hypertension is due to anexity and not due to other organic cause ?

note that ...
he measured his BP more than one time and it was high
one time 160/90 and the other is 160 / 80

by the way ,, systolic hypertension is more evident
may be due to atherosclerosis or other cause

i think the increase in the intensity of the murmer is not due to his MVP
but it is likely to be due to the hypertension
as increase blood rush by the high BP increases it's terbulance and so increasing the intensity of his murmer

so here i will assure him about his original disease MVP ,, and say it's not aggrevated or worsen
but it's due to the high BP which is not as aresult of your original disease but may be due to other cause
and whatever the cause ... it urgently need treatment to lower your BP

( MVP and HPN may act as predisposing factors for further heart problems .. so the HPN must be treated and investigated to know the cause )

thanks dr salam ....

waiting for further discussion