Q. Do I have HCM or something else?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
Published on May 09, 2018

Hello doctor,

I am a male aged 56 years. I am having a musculoskeletal problem. 14 years back I was diagnosed bone TB and treatment was taken. Problem recurred four years later and diagnosed as ankylosing spondylitis (AS). Despite on biological injection for 10 years, efficacy reduced and became ineffective affecting mobility very badly. Ten months back another rheumatologist said it is not AS and suggested me to take massage treatment. I had a second opinion with another rheumatologist, she also confirmed it is not AS. She said myofascial pain syndrome and another pain specialist called it fibromyalgia. Hence, I am not sure about the diagnosis. As it stands it may be myofascial pain syndrome or fibromyalgia. As per their advice, I stopped all medications for AS and is continuing massage. With very very limited mobility, presently it has improved (approximately 500 m once or twice a day).

Coming to the problem related to heart for past ten years (admitted for AS) till today, I had taken ECG and echo several times. I underwent angiogram since I could not complete TMT. I have provided all these details in the attachment in chronological order for easy reference. I have also attached my latest blood test report.

Presently, I am feeling very mild fast breathing (age related) during walking (500 m) and subsides in two minutes after the walk, but no pain. No difficulty if walk a shorter distance. I had chest squeezing (costochondritis) like feeling losing up to one minute many times earlier. I never felt pain in other places. When I informed my rheumatologist earlier, he mentioned if it is severe it can be looked into. Hence, I have not given much weight, thinking it is non-cardio. The problem I am facing is, whenever I take ECG, I was frightened stating heart attack took place. When I went to the hospital ten months back for vomiting, I was put in ICU. They conducted blood tests, echo and seen angiography report. There was no indication of attack and then got discharged.

Five months back, the doctor mentioned it as hypertrophic cardiomyopathy (HCM), said is there from childhood, ECG showed an abnormality, nothing to worry, suggested not to do strainful work and prescribed medicine. I consulted the doctor who attended me ten months back. When I asked him about ECG abnormality, he did not accept HCM and said a mild attack took place. I never had any difficulty with an attack on any occasion earlier. Hence, I am confused. The echo impressions on various occasions are as follows: grade 1 impaired LV diastolic function, concentric left ventricular hypertrophy and hypertrophic cardiomyopathy.

ECG: showed LVH+ on four of these reports. My height is 167 cm, weight is 65 kg. BP 120 to 130/80 to 85, pulse normally bit high 90. Presently I am taking Angizem CD 90 once daily, Clopilet once daily and Roseday 5 mg once daily. Angizem gives mild swelling at feet. hs-CRP is 5.1 and is the first time showed a higher value. I request you to kindly go through the reports. I would like to know the following:

  1. What is my problem? HCM or anything else?
  2. Whether any attack has taken place.
  3. Why ECG is always showing abnormal?
  4. Whether this problem is related to a musculoskeletal issue that is non-cardio.
  5. Is feeling of squeezing of the heart is cardio related?
  6. Kindly prescribe medicine. Any advice?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

I have gone through your reports and summary (attachment removed to protect patient identity). You do not have HCM (hypertrophic cardiomyopathy) and also do not have had any heart attack. There are changes in the ECG (electrocardiography) which is called as strain pattern, and these changes are due to hypertension. The same hypertensive changes can be seen in echocardiography as concentric LVH (left ventricular hypertrophy). Also, your angiography which is the gold standard test for heart attack was not showing any major problems. So at this point, you do not need to worry about your heart status. At this point, you just have hypertension and some slow flow in your heart arteries which is not at all worrisome. In your reports, your hs-CRP (high sensitivity C-reactive protein) and fasting blood sugar is on a higher side, but nothing to worry about it. You are already having Roseday (Rosuvastatin) which will be helpful in patients with elevated hs-CRP.

Next thing, Angizem (Diltiazem) is not a choice of drug for hypertension, nowadays, and you are having swelling in the legs, so my advice is to change it to tablet Telma (Telmisartan) CTD 40/12.5 mg once a day. So your priority at this time is healthy lifestyle and control of BP. You should have a healthy lifestyle like avoiding fatty, oily and high-calorie diet. Have low salt diet and monitor blood pressure regularly thrice a day for one week then once or twice a week. BP should not be persistently more than 140/90 mmHg. Regular exercises like brisk walking, jogging according to your capacity at least 30 minutes a day and five days a week. Lots of green leafy vegetables, fruits, fish once or twice a week, avoid meat. Avoid smoking and alcohol if any. There should not be any abdominal fat deposition or obesity.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

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