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Case # 2

( Heart Failure )

Case # 2 - Question:

Sat, Jul 16, 2005 3:15 am

Dear Dr Azmoon
I would like discuss with you from Tehran/Iran about patient 15 years
old with cardiomyopathy : from 15 months ago till now. he takes:
-Carvedolol 6.25mg 1/2 tablet TDS
-digoxin 25mg 1/2 10am      1/2 tab 10pm
-spironolactone 1 tab 6-2-10
-enalapril 5mg 1/2tab 10am 10pm
-forezmaid 1tab Q6h
-A.S.A 100mg daily
-flixotide 2 puff morning & night
-evohalev " "       "             "
-serobied " "       "             "
multivitamin & ferrous sulfate daily
nitroglycerin PRN
now his general condition is not good, he has edema and ascites, weakness,
lose weight and can not walk.
heart transplantation had recommended to him. I want to know what 's your
option or your recommendation for him.
I send you all exam about patient with cardiomyopathy from Tehran/Iran
count.  Liver function exams and renal exams are normal. 

Pulmonary Function shows: severe expiratory flow limitation or very severy restrictive defect.

Echocardiogram exam: LV EF 35%.

Patient's Condition is: Male, 14 years old, Height 167cm, Weight 38kg.

I want to thank you in advance.
Thank you for your email and your kindness

Kind Regards, ____________
TUMS

 

Case # 2 - Answer:

Mon, Aug 29, 2005 4:40 pm

Salam Professor Mohtaram... omeed varam halatoon khoob bashad...  khaily narahat shodam az shenidan in javan.  enshallah harche zood tar behtar shavad...  khaily dalil hayeh mokhtalef vojood darad baraye heart failure (HF) = zaeefee mahiche ghalb.   aya iin javan az bachegee beemaree ghalbee deegaree ham dashte? dar famil oo chetor?  aya momken ast keh beemaree ghalbee dar oo vojood dasht vali penhan ta chand mah peesh, va ya inke hamichee normal bood, va yek on be beemaree ghalbee va alaem ha dochar shod?   echo neshon dad keh EF < 35% vali niaz ast bedooneed keh che joor cardiomopathy, aya hypertrophic, va ya dilated..  restrictive cardiomyopathy ham vojood darad, vali, osoolan dar restrictive EF zeer 40% neest..  hypertrophic dar javan ha vojood darand, va meeshenaveem gah gahee keh yek javan dar varzesh meeofte va az foot meekonad, beeshtar moghe-ha dar javan ha HCM vojood dasht (hypertrophic cardiomyopathy = HCM)...  man hats meezanam dilated....  va DCM = dilated cardiomyopathy dalil hayeh khaily ziadee darad.. 50% dalil HF bedoone tashghees dalael meebashad = approximatelty 50% of HF is idiopathic in cause.  baad yek meghdar rapt beh beemaree rag ghalb darad; shomare 2 baad az idiopathic meebashad, va #3 = myocarditis, keh varam mahiche ghalb va baad HF keh dar javan ha khaily haad tar ast; yani more fulminant...   varam mahiche beh dalil hayeh mokhtalef vojood darad..  yeki az dalael virus...  va ya beemaree hayeh deegar...  EMB = biopsy mahiche ghalb komak beh diagnose dalel varam ghalb mokonad, hamontor komak baraye diagnose DCM agar dalil vazehee vojood nadarad...  HIV nazdeekan dar 4% mogheha momken ast dalael bashad... dar zemn yek echo kamel lazemn ast keh motmaen basheem dariche ha chetor hastand...  dar meeyan hal niaz ast keh optimal after load reduction as well as preload reduction agar moshkel dariche aort nadarand.  niaz darand keh yek doktor takhsos ghalb bache ishan ra bebeenad baraye tashghees kamel tar... va keh EF paeen tar naravad... benazar meeyad az email shoma keh clinical symptoms in javan daran beeshtar meeshan va mohmn ast keh tahte nazar bashand, in javan has would be considered high risk baraye sudden cardiac death, and may benefit from an ICD as long as course is stable.  another question is there reversibility to his contractilty dysfunction and if yes, is then there really a need for transplant?  for example if he has severe valve disease and his valve is replaced, some of his EF may imporve in some cases.   criteria for heart transplant in patients in the US are usually with severe debilitating heart dysfunction, with severe clinical manifestation, with EF 5-10 %, and these patients often are in need for LVAD = left ventricular assist device...  please keep me updated.  khosh-hal meesham dar morede archive pezeshki oo beeshtar bedoonam. 

moaffagh basheed, feshar roohee kam tar va az zendegee khod lezzat bebareed...

shahdad

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