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Infection with PLEURAL FLUID, DILATED CARDIOMYOPATHY. Is PACEMAKER needed?

Resolved Question:

Dear Sir/Madam,

My dad just discharged from Hospital on 17th February, 2015. He was suffering from plural infection with Plural Fluid and dialted cardiomyopathy with poor systolic function 20%. Detailed reports and Discharge Summary is attached herewith.

1.1 Ltr of Plural Fluid is removed from the patients body on 12th February 2015 and after that his Systolic function is improved to 30% on 13th February 2015. Doctor did not perform anymore Echo Cardiogram to monitor systolic function after that and informed us verbally to install Pacemaker immediately.

So, my kind request to you that please let me know whether we need to install PACEMAKER now, or to wait.

Also, if possible please advice me what to do now.


Category: Cardiologist

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Category: Cardiologist
Dr. Vivek Mahajan is online now

Expert:  Dr. Vivek Mahajan replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com

Your father is presently suffering from dilated cardiomyopathy with left ventricular failure and severe mitral regurgitation. Also there is a pleural effusion which could be due to heart failure or tuberculosis as per investigations. Did your father have this diagnosis of dilated cardiomyopathy for a while now or is it a recent diagnosis. If it us a long standing process of poor heart function then a AICD would be indicated for primary prevention of sudden death. If all the problems have begun recently then it would be appropriate to wait for few months before taking a decision on AICD. The heart function may improve spontaneously in case of certain infection in body. But if ot doesnt go beyond 35 percent after aay 6 months then AICD is indicated. As far as pacemaker is concerned it is for slow heart rates. Does he have slow heart rate? Please upload ecg. Given that he is on tuberculosis treatment it would be better to wait for 6 months before any pacemaker or Aicd if not urgently indicated fir low heart rate. Also a coronary angiography to look for cause of heart failure would be appropriate and can be done right away.
Regards
Dr Vivek Mahajan
DM Cardiology


Patient replied :

Dear Doctor, Thank a ton for your reply. Please note that the issue mentioned to you is a current issue. The last ECG report shows 'Left bundle branch block'. Kindly advice. Regards, Rajat


Expert:  Dr. Vivek Mahajan replied 3 Days.

Hello,

If the issue is a new one and not a lpng standing one you should wait for spontaneous improvement in lv function over next few months. If the ecg shows lbbb and the function doesn't improve he should undergo a coronary angiography and if no significant blockages he may be a candidate for CRT-D which is not exactly a pacemaker but somewhat similar. Still you should wait for sone time for tb treatment to be completed and heart function may show spontaneous improvement.

Regards
Dr Vivek Mahajan


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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