How to manage COVID-related lung and heart complications?

Question

Hello doctor,

My father is 72 years old and weighs 178 pounds. He has asthma and diabetes and has been taking tablets Gemer and Dapacose 10 mg for the past 25 years. Two years back, we did a checkup, and all his heart reports were good. Last year, he had COVID with 40 to 50 % lung infection involvement. He was admitted to the hospital with oxygen support for a week, and he recovered. Here, I share my father's current condition.

Recently, he had more asthma symptoms even without getting a cold, so we visited a cardiologist. There, he underwent ECHO and ECG, which revealed left ventricular diastolic dysfunction, moderate pulmonary artery hypertension, and mild tricuspid regurgitation. He has been prescribed Nebicard 5 mg, Eptus 25 mg, Assurans 20 mg, and Pleorose CV 10 mg and was referred to a pulmonologist. The pulmonologist prescribed two inhalers and a tablet of Montair AB.

I have a few concerns. We see a high value of "NT proBNP - 418 pg/ml." is this related to this heart condition? Currently, he is on a lot of medications. Are all of these medications needed? Will it affect his liver or kidneys? Is the heart condition reversible? Can lifestyle modifications reverse it? Normally, at this age, can these medications prevent the diastolic dysfunction from going to grade 3? Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your query. I understand your concern. The NT pro-BNP (Natriuretic peptide tests) is slightly higher as the patient's age is 72. It is increased due to pulmonary hypertension secondary to lung pathology (COVID and asthma), not because of the heart, but because LV (left ventricular) systolic function is normal.

I suggest you to follow the instructions mentioned below. Diabetic medications should be continued. Continue taking beta-blockers and a tablet with Rosuvastatin and Clopidogrel as they are good for the heart and also beneficial in the prevention and treatment of diabetics. Continue taking half a dose of Eplerenone, a selective aldosterone receptor antagonist. It is a diuretic that can be taken as it improves diastolic function, but if it is expensive, you can ask for an alternative. Use inhalers and Acebrophylline and Montelukast for asthma (a chronic respiratory condition).

If pulmonary hypertension improves and no asthma findings are seen, then the inhaler may be reduced, as per the pulmonologist. Currently, all medications are important. The cardiac condition looks good. The main problem is diabetes and pulmonary hypertension. These medicines are adequate and will improve his quality of life and longevity.

Kindly consult a specialist, talk to them, and take the medications with their consent. I hope this has helped you. Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Suppose pulmonary hypertension is secondary to some part of lung tissue damage (permanently) in COVID-19. In that case, he needs to continue taking medicine, which the doctor can titrate according to pressure findings in an echocardiogram (ECG). He can do respirometer exercises. He can do light exercises like you mentioned till he is not feeling uncomfortable or breathless. Do not do intense workouts that may trigger any breathlessness event. He can travel if he is comfortable walking or climbing stairs, if any. Someone can accompany him and keep an inhaler handy if he is breathless.

I hope this helps.

Please revert so I can assist you further.

Thank you.