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Are There Chances Of High BP Or Other Complications In Type 2 Dibetic Patient? Suggest Preventive Care?

Posted on Thu, 26 Dec 2013

Question: Hi, Let well-experienced XXXXXXX cardiologist address this - My mother-in-law is diabetic (type 2), dyslipidemic, has subclinical hypothyroidism, osteoarthritis on hip, knee, ankle and seems prehypertensive too. She has osteoporosis and Vit-D insufficiency too, as confirmed by doctors. As she had swelling on both the legs around ankles and whole foot for nearly 10-15 days and on face near nose for 2 days long ago, one cardiologist suggested to go for ECHO. The ECHO taken today has the result as • Normal Sixed Heart Chambers • Borderline Concentric LVH • Tips of AML Prolapse with Grade I Mitral Regurgitation • Other valves are normal and competent • No regional wall motion abnormalities at rest • Normal LV Systolic Function (LVEF: 71%) • Grade I LV Diastolic Dysfunction • No PAH; No Pericardial Collection What does this mean? How is her heart's health and what're the possibilities for the future - at present state not being addressed? Is she having chances to have High BP and any other complication? What is the remedy - please suggest from preventive care perspective too?

Answered by Dr. Indu Kumar (7 hours later)

Brief Answer: Her ECHO reports are almost normal as per her age. Detailed Answer: Hello Thanks for writing to XXXXXXX With medications your mother in law is in good health. She is getting right medicines and she should continue these medicines.Additionally she need medicines for dyslipidemia. Her blood glucose is acceptable,but try to keep fasting blood sugar around 100 mg%.Besides drugs for diabetes mellitus,her diet should be controlled and walking should be done. Her lipid profile is also altered specially LDL so tablet Atorvastatin 10 mg should be taken at night after dinner and it will help in good control of lipids. Her TSH is also not acceptable.Talk to your physician regarding increasing dose of Thyronorm to 100 micrograms.It may be the cause of leg swelling. Her ECHO reports are normal. There is no need to worry at all.Borderline concentric LVH(Left ventricular hypertrophy is due to aging and hypertension).Grade 1 LV dysfunction is acceptable in her age.Grade 1 mitral regurgitation due to AML prolapse is also acceptable as per her age.Other findings are normal. She should be encouraged for walking and be active in daily activities.she should avoid saturated fats and red meat.Take lot of fruits and vegetables. Uncontrolled hypertension has deleterious effects on many body systems.So,it should be kept in controlled value. You should also get her examined by ophthalmologist.It is necessary due to her physical illnesses.Diabetes mellitus and hypertension causes complications in eyes.So,eyes should be screened. Get well soon Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (1 hour later)

Should we go for cardiologist consultation, in-person? Hers was 130/90, as endocrinologist checked yesterday. When the doctor checked last time, at both occasions (in 15 min interval) the readings were 140/90. As we checked using Digital apparatus, it wasn't consistently at 130/90 but was 60% at that range. She is not taking any medicine for hypertension now. Is she required to have medicine for hypertension too? What will happen if this ECHO impression has not been addressed to - any chances of heart failure, heart attack? Could you also let us know the initial symptoms of a stroke? Due to some unpleasant occasion, she had headache and pain on her left leg. She could not sleep till 2 A.M, but was conscious and talking normal. Is it very initial sign of a stroke?

Answered by Dr. Indu Kumar (13 hours later)

Brief Answer: She is in Prehypertension stage Detailed Answer: Hello Thanks for writing back She is in Prehypertension stage and may cross 140/90 mm Hg any time which is now considered as hypertension stage according to definition. She need regular monitoring of her B.P.If she complains of headache,dizziness etc then antihypertensive medicines can be started. There is no emergency of contacting cardiologist at present.She is getting right medicines and she also doesn't have any cardiac complains. Her ECHO reports is almost normal and there is nothing to worry about.There is no chance of cardiac failure or heart attack due to ECHO findings. Heart stroke symptoms include pain radiating to back or left shoulder,breathlessness etc.If she ever complain of these symptoms then it should be taken seriously. Brain stroke symptoms include paralysis or weakness of limbs,not able to speak etc. Headache and pain on her left leg is not related to stroke at all. Get well soon. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (7 minutes later)

So, on priority we need to address her cholesterol issue to avoid heart attack in future: as she has gotten onto that boat, though no immediate risk.. followed by her BP.. let me know, if anything else is important..

Answered by Dr. Indu Kumar (16 hours later)

Brief Answer: Need attention for hypertension and dyslipidemia. Detailed Answer: Hello Thanks for writing back Yes,she need attention for dyslipidemia and borderline hypertension. She need regular monitoring of blood pressure.Lipid profile can be repeated after one month since she start taking atorvastatin.These diseases take long time to develop complications. She is not at risk at present.TSH level also need attention.You can discuss with your doctor. Get well soon. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar