Friday, December 6, 2019


    When my children were young and could not find out their books or note books or a shirt or something, my wife would go and find it in less than a minute. Her comment would be 'If you look for it you will find it . But I think it is same thing when I am looking for something in kitchen cabinets. If I can not find it , she can find it in seconds. Again the statement is if you look for it you will see it. I have seen this medicine and I have used a line (borrowed from someone),Your eyes don't see what your mind does not see.But sometimes I wonder if it is 'Not thinking ' or 'not looking'.This brings me to today's story.
     I saw this patient for shortness of breath. She was 77 years old female who had some shortness of breath and it was not bad . But the further work up was done by cardiologist and she had not seen lung specialist . She was told to have aortic valve problem and so she was sent to cardiac surgeon and she had surgery . She had chest x- ray and ultrasound of the heart and cardiac catheterization to make sure that she did not have any blockage in coronary arteries. She had new technique for the surgery.She did very well. In this type of surgery the chest is not opened  and it is minimally invasive  and so she did well. She had some shortness of breath and she saw primary care MD  and then she felt she will recover in some time and she did . She was better.
   In next to few months , she again started having some shortness of breath. She was seeing the cardiologist who told her that her heart was OK.She was tried on some inhalers for possible asthma.She felt little better  and this was continued . But she still did not feel that she was cured.So the Primary care MD sent her to me . She had chest X- ray and that was clear and we did new breathing test .That was almost normal but one could make  a case for mild asthma based on certain numbers or values on it .So I started her on  different inhaler which had 2 drugs  and also a nebuliser
treatment at home . She came to see me couple of more times . I was trying to get some information from cardiologist  and the only ultrasound -or echo cardiogram I could find was one that was done before the surgery for aortic valve.I talked to her  and she saw the cardiologist on follow up and she was again told that she was fine as far as her heart was concerned . I was not much convinced that she had bad asthma, as the cause of her breathing problem.I was concerned about cardiac etiology of her.But with cardiologist doing the follow up I had to do lung work up. But when I could not find any 'cardiac tests' from cardiologist , I decided to do new cardiac  tests. I did call the cardiologist and ordered new echo cardiogram. It showed that she had  different valve which was leaky and the pressure in the lung blood vessels was increased- may be related to the leaky valve . Her old test had shown the pressure was elevated. So the problem was the HEART and the elevated pressure in lung circuit.
    I started her on some treatment and told her to have cardiologist do new cardiac cathetarization. we can treat the pressure with different medications but they would need actual pressure from heart catheterization  . 

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