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What Are The Symptoms Of Cardiomegaly?

Posted on Wed, 13 May 2015

Question: Dear Doctor,
My mother, (72years) has diabetes and thyroid problem. Recently when she had flu, our family doctor prescribed an X-Ray examination to eliminate swine flue and we noticed she has cardiomegalia.
I attach all the medical records from doctors consulted and medicines she is taking.
We would like to do an exhaustive diagnosis of the actual problem before looking at a possible line of treatment.
Can you please list out a range of tests that she need do for an accurate diagnosis of her problem after which I will get back to you with the results for a recommendation of a line of treatment.
Thank you
XXXX

Answered by Dr. Ajish TP (8 hours later)

Brief Answer:
annual blood tests to be done

Detailed Answer:
Hi Mr XXXXXXX

Welcome to HCM. I have gone through the question and understand your concerns.

Since your mother is having type 2 diabetes and hypothyroidism, she should have some annual blood tests done. This includes:

1. HbA1c
2. Renal function tests
3. Liver function tests
4. Serum electrolytes, calcium, phosphorus
5. Blood and urine routine
6.urine albumin creatinine ratio
7. Diabetic retinopathy screening by ophthalmologist
8. Clinical examination for neuropathy and peripheral pulses
9. Anti TPO antibody - to see if thyroid dose can be reduced

For cardiomegaly additional investigations needed are

1. Repeat chest x Ray to see the previous lung patch is completely cleared
2.ECG
3. Echo cardiography

I have gone through the reports uploaded.

Her diabetes is well controlled - normal HbA1c and FBS.

Her thyroid function is also normal. TSH is on the lower side. But don't adjust dose based on that as this may be due to the flue or the steroid medication she was on for breathlessness. You can repeat the thyroid function tests after 1 month and adjust dose based on that.

It is better to vaccinate her with pneumococcal and influenza vaccine as a preventive measure.

Hope I have answered your questions. If you have any further queries I will be happy to help you.

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Ajish TP (1 hour later)

Dear Doctor,
Thank you for your detailed reply. We will indeed carryout the tests prescribed by you. I however have a few more questions on my mother's condition:

1. Is Cardiomegaly related or as a consequence of the diabetes and thyroid medication taken by my mother?
2. is it possible to correct cardiomegaly by reducing the dosage or changing the current drugs used for controlling her diabetes and thyroid condition?
3. Is there any particular drug that she takes now that might cause cardiomegaly and if so can it be eliminated or replaced with some other drug?
4 If cardiomegaly is a separate condition will she require other drugs apart from the ones she takes for diabetes and thyroid for controlling it.
5. If cardiomegaly is a separate entity by itself and not related with endocrinology, then who should we contact for an expert opinion. A cardiologist?

Thanks once again,
brgds, XXXX

Answered by Dr. Ajish TP (21 hours later)

Brief Answer:
See detailed answer

Detailed Answer:
Hi XXXXXXX

Welcome back. The answers to your questions

1. Cardiomegaly is not related to diabetic or thyroid medications

2. Cardiomegaly can be seen in both diabetes and hypothyroidism - cardiomyopathy in hypothyroidism and hypertension or cardiac disease commonly associated with diabetes can cause cardiomegaly

3. Cardiomegaly in X ray may not always be a true Cardiomegaly. So you have to do an echocardiogram to confirm that. Transient Cardiomegaly can be seen in respiratory infections.

4. The treatment of Cardiomegaly depends on underlying cause.

5. You should consult a cardiologist for detailed evaluation.

Hope this information was useful to you

Regards
Dr Ajish TP

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

Follow up: Dr. Ajish TP (23 hours later)

Dear Doctor,
As suggested by you, I have got done the various bloodtests for my Mother and attach the report for your comments. Do let me know how to proceed further and what has to be done

Answered by Dr. Ajish TP (14 hours later)

Brief Answer:
These investigations are fairly ok

Detailed Answer:
Hi Mr XXXXXXX

Welcome back. I have gone through the reports.

My commends on lab reports:

1. kidney function tests and liver function tests are normal

2. Mild albuminuria -This test need to be repeated after 3 months to confirm.

3. Uric acid high - decrease protein intake ( meat, pulses, spinach etc)

4. Blood sugar is well controlled ( HbA1c 6.5%)

5. Urinary infection - pus cells. Do a urine culture and repeat urine examination. Is she having pain while urination?

6. Thyroid antibodies are high (Hashimoto's hypothyroidism) she need to continue the same dose of thyroid medications, probably life long.

These blood tests are fairly ok. Nothing to suggest the cause for cardiomegaly.

The next line of action will be.

1. Do repeat chest X-ray and ECG to confirm if there is cardiomegaly

2. If there is cardiomegaly, consult a cardiologist and do an echocardiogram to see the cardiac function.

3. Do a repeat urine examination and culture. If needed antibiotics for urinary infection

4. Repeat uric acid, urine albumin creatinine ratio after 2 months.

Hope this will help with her further management. If you have any further questions I will be happy to help you.

Regards

Dr Ajish TP

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