Dr. Muhammad Zohaib Siddiq
Cardiology
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Patient's Query
Hello doctor,
My mother is 47-year-old and is long-term hypertensive. She got diagnosed with diastolic dysfunction grade 1 after experiencing swelling in her feet, cough, and breathlessness three years ago with an E/A ratio of 45/42, mild TR, and concentric ventricular hypertrophy. And the recent test, it progressed to diastolic dysfunction grade 2 with E/A ratio 77/45 with mild TR and mild MR and the concentric ventricular hypertrophy still exists. After the diagnosis, she has been on medication. Three years back, she was obsessed with a weight of 216 pounds, but later she maintained her weight. Now, it is 169 pounds, and her symptoms are also under control. I wanted to know if the progression was serious or should we change the doctor. Kindly help.
Hello,
Welcome to icliniq.com.
Thank you for your query. I reviewed your query. The concentric left ventricular hypertrophy leading to diastolic dysfunction can be reversed by controlling blood pressure. I suggest you to follow a few instructions mentioned below. Please get basic blood tests, like TSH (thyroid stimulating hormone), urea, creatinine, electrolytes, and check your blood sugar levels. Take medicines, preferably ACE inhibitors, with or without other medicines depending upon blood pressure levels. Kindly consult a specialist, talk to them and take the medications with their consent. Maintain a blood pressure of 120/80 mmHg. Apart from this, weight loss is essential. BMI (body mass index) should be as close to 21 as possible. Target safe weight loss is one to two pounds per week. The waist circumference should be below 31 inches. Also, have a fasting lipid profile test and keep LDL (low-density lipoprotein) levels near normal. If she has shortness of breath, get NT-proBNP (natriuretic peptide test) levels done. Over a few months, LV (left ventricular) remodeling will begin to reverse. I hope this has helped you. Thank you.
Patient's Query
Thank you doctor for the reply,
It is really helpful, but more specifically, I wanted to know the possible reasons for the sudden rise in the E/A ratio and the progression to grade 2 even after regular medication for BP, diuretics, and beta-blockers. Can we reduce this E/A ratio? I am really scared about the progression. Please help
Hello,
Welcome back to icliniq.com.
Echocardiography is purely operator-dependent, and there is a margin of error. Diastolic function is not only assessed with mitral inflow pattern but also other parameters like tissue Doppler imaging and pulmonary venous flow pattern, tricuspid valve regurgitation, etc. Controlling blood pressure will improve diastolic function once LV (left ventricular) hypertrophy decreases.
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Cardiology
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