My husband has been having shorntess of breath and some wheezing with activity.He also sweats heavily, even when eating. He is overweight and 46 years old witha family history of heart disease. He recently had a nuclear stress test that hewas not able to

	Asked by smboulet (Male; 45; Until this last month he has no medical history except an appendectomy in 2007. He has recently begun treatment for Borderline HTN. He is morbidly obese--5'10.5" and approx 330lbs; Relevant drugs:Lisinopril 10mg 1 tab daily, ASA 81mg 1 tab daily ) on Mon 07, Dec 2009 02:20pm :
	My husband has been having shorntess of breath and some wheezing with activity. a couple of years ago he had a chest xray which showed an enlarged heart. He also sweats heavily, even when eating. He is overweight and 45 years old with a family history of heart disease. He recently had a nuclear stress test that he was not able to complete. the preliminary results showed "Possible Critical Heart Condition" and he has been referred for Heart Catheterization. He is naturally very scared. His does not have hardly any hair left on his legs below the knees and does get some mild edema in his lower extremities. He has a large abdominal girth. His labs were within normal range and his doctor just put him on Lisinopril 10mg for borderline HTN along with 81mg ASA daily. His paternal grandfather, father, and his father's brother all died between 45 and 56 of heart attacks. Could you give me an idea what we may be facing so that I can be prepared?
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	Answer by Dr.Kokil Mathur (doctor) on Mon 07, Dec 2009 09:26pm: Hi Welcome to the AMD forum! With such a strong family history of heart disease you are rightfully concerned about your husband’s health. I am sorry to say but I’ll be upfront with you and not mince words because this is a serious matter. Your husband has a very huge chance of having blockage in the heart vessels. Since X-rays had shown an enlarged heart, it should have been investigated especially since he is morbidly obese (as you put it) and has such a strong family history and is symptomatic even at rest and on mild exertion. Enlarged heart can be due to dilated cardiomyopathy where the heart dilates or it can be due to hyperthrophy of the muscles of the heart. You also mention that he has a huge belly with hair loss in the lower extremities. Hence the possibility of adrenal gland dysfunction and Cushing Syndrome should be looked into. Other causes of obesity like low thyroid function and diabetes too should be looked into. Type 2 diabetes is common in obese and adds to their obesity. Also since he is symptomatic even at rest (sweats while eating and shortness of breath) things would not be too good. Apart from block in blood vessel there is a chance of heart problems and multiple endocrine gland involvement. Since there is wheezing too there is every chance that lung is getting secondarily involved. Please go as per the advice of the cardiologist. You may also need to consult an endocrinologist. Get your husband admitted ASAP. Hope this helps you understand the gravity of situation, which as I understand you are already partially aware of. Please let me know if there is any thing else and do keep me posted. Take care!
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	Comments: Response by Dr Bhupinder K, MD on Mon 07, Dec 2009 11:45pm: Hello, It has been rightly mentioned by Dr Kokil that such a strong family history predisposes your husband to a heart disease. Moreover the chest x-ray and nuclear stress test have confirmed its presence. From the symptoms, the possibility of coronary artery disease cannot be ignored. In this the blood vessels supplying the heart have atherosclerotic cholesterol plaques which may block the flow of blood to the heart. This makes the heart to pump more and exert more. It also causes the wheezing and shortness of breath because the heart exerts more and there is a deficit of blood reaching the lungs and other parts of the body. Chest x-ray can show abnormalities in the size or shape of the heart and can show whether any fluid is building up in the lungs. I completely agree with your husband’s cardiologist that cardiac catheterization is required. Coronary angiography by cardiac catheterization is the best way to evaluate coronary heart disease. Not only that, it is the only test that helps a cardiologist to determine whether your husband requires bypass surgery, a less-invasive technique such as angioplasty or stent placement, or just medications. So my sincere advice is to go in for this test as soon as possible. I hope it helps. Take care and please do keep us posted in case you have any additional doubts. Kind regards. Comment by Unregistered on Tue 08, Dec 2009 06:24am: Thank you for your help. I work in the medical field and have been concerned about him for some time, but he would not seek medical attention until I Bullied him into it. We have been married for 23 years and he is my best friend. I knew the possibilities but I really needed my fears confirmed so I could prepare. It is always different when you are on the other side of the examining table, so to speak. I will let you know the outcome of today's visit. Comment by Unregistered on Thu 14, Jan 2010 03:24pm: We did have a heart cath which was clear! I am trying to get him to exercise and eat better but he still has the same symptoms. Now that the heart cath is clear and the doctor told him he was unlikely to have a heart attack in the next 10 years he really is not interested in doing any better. Response by Dr.Kokil Mathur on Thu 14, Jan 2010 07:08pm: Hi! Thanks for the update and keeping us posted. It is so good to hear from you. I am relieved that it is not a blockage in the heart. I am sure you must be more relieved than I am. Yes, it is understandable—your husband’s reluctance to take up exercise etc in view of the cath report. However as I mentioned earlier, get a complete endocrine check up too especially for thyroid, diabetes and adrenal glands. If he gets a clear chit there too, then he would need to join a good diet and nutrition expert and a physical trainer to increase his fitness level. So follow this up with a more relaxed state of mind. Take care!
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