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I'm A 70 Year Old, Morbidly Obese (270 Pounds) Female,
Question: I'm a 70 year old, morbidly obese (270 pounds) female, with overall Cholesterol of 202, and NT-proBNP of 332. Besides losing weight is there a medication I can use to reduce my mortality to heart failure?
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome to Ask a Doctor service!
I understand your concern an would explain that NT pro BNP levels are closely related to the weight.
So, it is true that reducing your weight will help improve your cardiac function and heart failure prognosis. I would recommend consulting with a dietitian for this purpose, to help you lose weight.
I would like to know if you have symptoms of heart failure like: shortness of breath during daily activity, leg swelling, etc..
I would also like to review your cardiac ultrasound report for a second opinion, if you could upload those results for me to review.
Unfortunately, there is no specific drug which can make miracles in such cases.
But, Coenzyme Q10 and Carnitine are well known to improve the myocardial function and help reduce the mortality from heart failure.
If you are taking any anti-hypertensive drugs, I would recommend ACEI (ramipril, berlipril, etc.), if there are no counter indications, because they are known to improve the outcome in patients with heart failure.
Light and regular physical activity can help improve your heart function too.
As your cholesterol levels are borderline, I would not recommend taking any statins, because they may harm the myocardial tissue in patients with heart failure. A healthy diet (Mediterranean diet recommended) will help reduce cholesterol levels naturally.
A follow up with NT pro BNP levels and cardiac ultrasound after 6 months in order to investigate for the possible progression of heart failure.
Hope you will find this answer helpful!
I remain at your disposal in case of further uncertainties!
Kind regards,
Dr. Ilir Sharka, Cardiologist
I would recommend as follows:
Detailed Answer:
Hello!
Welcome to Ask a Doctor service!
I understand your concern an would explain that NT pro BNP levels are closely related to the weight.
So, it is true that reducing your weight will help improve your cardiac function and heart failure prognosis. I would recommend consulting with a dietitian for this purpose, to help you lose weight.
I would like to know if you have symptoms of heart failure like: shortness of breath during daily activity, leg swelling, etc..
I would also like to review your cardiac ultrasound report for a second opinion, if you could upload those results for me to review.
Unfortunately, there is no specific drug which can make miracles in such cases.
But, Coenzyme Q10 and Carnitine are well known to improve the myocardial function and help reduce the mortality from heart failure.
If you are taking any anti-hypertensive drugs, I would recommend ACEI (ramipril, berlipril, etc.), if there are no counter indications, because they are known to improve the outcome in patients with heart failure.
Light and regular physical activity can help improve your heart function too.
As your cholesterol levels are borderline, I would not recommend taking any statins, because they may harm the myocardial tissue in patients with heart failure. A healthy diet (Mediterranean diet recommended) will help reduce cholesterol levels naturally.
A follow up with NT pro BNP levels and cardiac ultrasound after 6 months in order to investigate for the possible progression of heart failure.
Hope you will find this answer helpful!
I remain at your disposal in case of further uncertainties!
Kind regards,
Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much Dr. Sharka. I do not have a cardiac ultrasound report as far as I know. What I sent you is what the evaluating company sent me. I do get short of breath and my legs always swell, especially the feet and ankle. I also take 25 mg. HCTZ for the HBP. Should this possibly be evaluated for a different medication in light of these new findings? I have dieted most of my life. At one point I was over 400 pounds, had Roux-N-Y, went down to 238 pounds in a year. Even then I yoyoed. Fed up, I tried the Duke University diet and went down to 199 pounds in a year. I was 19 pounds from my goal of 180 but I guess I got tired of the carb-free diet. I will certainly try the Co-Q10. What is the difference between Carnitine and L-Carnitine compared to the Co-Q10 please?
Respectfully,
JoAnn Capozzoli
Respectfully,
JoAnn Capozzoli
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again JoAnn,
I understand your concern and would explain that Carnitine and L-Carnitine is the same thing.
You should know that Carnitine and Coenzyme Q10, both contribute in the energetic cycle inside the myocarial cell, by producing energy from glucose and fat , but they act different roles in this process. Let me explain further:
CoQ10’s most prominent role is to facilitate the production of ATP by participating in redox reactions within the electron transport chain in the mitochondria.
Carnitine works with several enzymes as a sort of cellular escort service. It latches onto fats and ferries them into the mitochondria. On its way out of the mitochondria, carnitine drags along potentially toxic by-products of the energy conversion process.
Heart muscle prefers to use fat rather than sugar for energy.Taking extra carnitine could ensure that the mitochondria have ample supplies of fat. Research also indicates that extra carnitine may nudge heart muscle to burn more sugar.
For this reason, I would recommend both these supplements in order to improve the myocardial performance.
I would also recommend performing a cardiac ultrasound in order to examine better your heart function and structure.
If your legs swell persistently adding furosemide (another diuretic) to your therapy may be needed.
Hope you will find this information helpful!
I remain at your disposal in case of further questions whenever you need!
Wishing all the best,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again JoAnn,
I understand your concern and would explain that Carnitine and L-Carnitine is the same thing.
You should know that Carnitine and Coenzyme Q10, both contribute in the energetic cycle inside the myocarial cell, by producing energy from glucose and fat , but they act different roles in this process. Let me explain further:
CoQ10’s most prominent role is to facilitate the production of ATP by participating in redox reactions within the electron transport chain in the mitochondria.
Carnitine works with several enzymes as a sort of cellular escort service. It latches onto fats and ferries them into the mitochondria. On its way out of the mitochondria, carnitine drags along potentially toxic by-products of the energy conversion process.
Heart muscle prefers to use fat rather than sugar for energy.Taking extra carnitine could ensure that the mitochondria have ample supplies of fat. Research also indicates that extra carnitine may nudge heart muscle to burn more sugar.
For this reason, I would recommend both these supplements in order to improve the myocardial performance.
I would also recommend performing a cardiac ultrasound in order to examine better your heart function and structure.
If your legs swell persistently adding furosemide (another diuretic) to your therapy may be needed.
Hope you will find this information helpful!
I remain at your disposal in case of further questions whenever you need!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Sharka:
Thank you once again. I have learned more from you in two days than I have learned from my Primary Care Physician in the almost 15 years he has been caring for me. I did send him my lab results yesterday, reminding him of my concerns, the date of my next appointment with him and if he felt I needed to see a cardiologist, the two that I would feel comfortable seeing.
I plan to start the two supplements you suggested as they couldn't possibly hurt anything at this juncture. I was going to Weight Watchers but if you think a Mediterranean diet would be better for me I will research that and follow that type of meal plan. I would have to leave the addition of the furosemide to my doctor as well as ordering the cardiac ultrasound.
I fully understand and appreciate that no doctor likes to be told how to treat their patient. However, this is my life. It is like the Johari Window. You and I know something about me that he doesn't. In order to save my life, he needs this vital and sound information to help me live a longer, healthier life. This is no time for me to worry about injury to his ego although he is a very kind and gentle man.
Thanks once again sir. I would like to keep in touch with you if I may, at least to have you look at the cardiac ultrasound once that is done and any repeat lab work.
Respectfully,
JoAnn
Thank you once again. I have learned more from you in two days than I have learned from my Primary Care Physician in the almost 15 years he has been caring for me. I did send him my lab results yesterday, reminding him of my concerns, the date of my next appointment with him and if he felt I needed to see a cardiologist, the two that I would feel comfortable seeing.
I plan to start the two supplements you suggested as they couldn't possibly hurt anything at this juncture. I was going to Weight Watchers but if you think a Mediterranean diet would be better for me I will research that and follow that type of meal plan. I would have to leave the addition of the furosemide to my doctor as well as ordering the cardiac ultrasound.
I fully understand and appreciate that no doctor likes to be told how to treat their patient. However, this is my life. It is like the Johari Window. You and I know something about me that he doesn't. In order to save my life, he needs this vital and sound information to help me live a longer, healthier life. This is no time for me to worry about injury to his ego although he is a very kind and gentle man.
Thanks once again sir. I would like to keep in touch with you if I may, at least to have you look at the cardiac ultrasound once that is done and any repeat lab work.
Respectfully,
JoAnn
Brief Answer:
I would be glad to review your test reports!
Detailed Answer:
Hello again!
I think that your doctor will be very cooperative with this situation, as GP already have this information.
Of course I would be glad to review all your test reports as soon as you will be able to upload them!
Please let me know about everything!
Wishing all the best,
Dr.Iliri
I would be glad to review your test reports!
Detailed Answer:
Hello again!
I think that your doctor will be very cooperative with this situation, as GP already have this information.
Of course I would be glad to review all your test reports as soon as you will be able to upload them!
Please let me know about everything!
Wishing all the best,
Dr.Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Kampana
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