How can shortness of breath be effectively managed?

Question

Hello doctor,

My mother, aged 64, has ischemic cardiomyopathy. Her angina and breathlessness have reduced, and they only occur when she exerts herself. However, she is experiencing nausea and dizziness even though she eats every two hours. A recent random blood sugar test showed values between 41 and 51 mg/dL, prompting us to give her some sweets. This issue persists even though she does not take any blood sugar medication. Additionally, her blood pressure is 86/60 mmHg.

A year and a half ago, she had a heart attack, and an angiography revealed triple vessel disease with two blockages. The doctor recommended a CABG, but we did not proceed because the patient was unwilling. She underwent EECP therapy for 35 days, which helped her significantly, allowing her to lead a normal life for a few months. However, her pain began to worsen again, and she developed water retention and breathing problems about a year ago.

We consulted a cardiologist who prescribed the following medications: Aspirin, Atorvastatin, Clopidogrel, Nitroglycerin, Nicorandil, Glimepiride, Metformin, Voglibose, Eplerenone, Torasemide, Amiodarone, Sacubitril, Valsartan, Ranolazine, Trimetazidine, Allopurinol, Thyroxine, and vitamin D supplements. She has been on these medications for a year. Previously, she was treated with Aspirin, Atorvastatin, Nicorandil, Clopidogrel, Nitroglycerin, and Isosorbide dinitrate.

A 2D echocardiogram done three days ago indicated an ejection fraction (EF) of 35 to 40 percent. She is diabetic, with a fasting blood sugar level of 87 mg/dL and a postprandial blood sugar level of 104 mg/dL. Her HbA1c is 8.2%, TSH is 11.27 mIU/L, uric acid is 8.5 mg/dL, and her vitamin D level is 10.41 ng/mL.

I would like an opinion on her current treatment regimen and suggestions for further management. Despite not taking Glimepiride, Metformin, and Voglibose for the past two days, her random blood sugar levels remain low at 40 to 50 mg/dL, causing her to feel dizzy and weak. I am uncertain about the cause of this, and any advice would be appreciated.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Your mother appears to have concurrent issues with her blood sugar and thyroid, along with heart problems. This creates a vicious cycle, leading to interrelated symptoms and worsening her overall condition. She has elevated TSH (thyroid-stimulating hormone) levels, which could be due to an underactive thyroid gland or problems with the pituitary gland (a small, pea-sized gland that plays a crucial role in regulating vital body functions) or the hypothalamus (a small area in the center of the brain). It would be advisable for her to consult her physician to adjust the dosage of her thyroid medications. I recommend taking her to an endocrinologist for more specialized input in this regard.

Her blood sugar control has not been optimal in recent months, as indicated by her blood tests. Currently, she is experiencing low blood sugar, and in this situation, it is best to have her diabetes medications reviewed by either an endocrinologist or a diabetologist available in your area. It is important not to stop any medications without prior consultation; however, given her low blood sugar levels, I would not recommend continuing any sugar-lowering medications at this time.

The thyroid gland also plays a significant role in how our body manages blood sugar levels. It acts as the control center for various metabolic processes in the body. Therefore, maintaining proper thyroid function is essential.

Your mother has low cardiac output, meaning her heart is pumping less blood than necessary to the body, which compromises the blood supply to vital organs like the kidneys. I also suggest considering CABG (coronary artery bypass grafting) for patients with triple vessel disease and significant blockages. If her health permits, she should contemplate CABG, as it can improve life expectancy.

Her dizziness and weakness can be attributed to low blood sugar and abnormal blood pressure. The low cardiac output results in inadequate blood flow to the brain, leading to her feelings of dizziness and weakness. Reduced blood supply to the muscles causes lower oxygen levels and nutrient delivery with each heartbeat, contributing to her weakness. If her heart issues continue, this may cause backup pressure in the lungs, leading to increased shortness of breath and other pulmonary complications.

I understand she has consulted a cardiologist for her shortness of breath, and I advise her to continue taking the medications prescribed by her cardiologist. Thank you for providing the details about her medications for my review. While angioplasty and stenting may not be beneficial for her situation, you may consult her cardiologist regarding this.

Additionally, her vitamin D levels are low. Encourage her to spend some time outside for a short walk or simply sit in the sunlight. This can help regulate her vitamin D levels, provided there are no issues with her liver or kidneys. Be sure to apply sunscreen to prevent any sunburn.

I hope this information is helpful.

Please feel free to reach out if you need any further assistance; I would be happy to help.