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Problems in the heart

Cardiac and dermatological problems are dealt with this time.


Jeyshree Jayaraman, Coimbatore:

My father, a retired pensioner, underwent a bypass surgery in March 2002. He has been complaining of chest pain occasionally, but is averse to seeing a doctor. We've been told that the pain will persist for at least a year. Is it normal? Is it best advised that he resumes his normal diet? He is a diabetic and has a problem with his B.P..

Dr. P. Ramachandran,

Cardiologist, replies:

Normally superficial pain in the chest may persist for three months after a bypass surgery. Chest pain occasionally does not mean anything. How long has your father had diabetes and high BP? Are they under control?

How old is your father? Since the surgery was done in early 2002, it is time he consulted the same team of doctors who performed the surgery. Control of diabetes and hypertension is mandatory. Following a strict diet and regular aerobic exercise like walking is essential. I am sure that your father is on various drugs like aspirin and statin in addition to drugs for diabetes and hypertension.

It is also recommended that your father undergo a treadmill test (if possible) to prove or disprove the cause of chest pain. Normally all bypass patients need continued surveillance.

* * *

Amit Singh, Kolkata:

I have been diagnosed with anterolateral wall ischaemia. What is this and what are the courses of treatment and various options available to me? What are the precautions to be followed? Is this serious?

Dr. P. Ramachandran replies:

Anterolateral ischaemia on the ECG may not signify any serious disease. High BP, a thick heart muscle and a block in arteries can cause ECG changes of anterolateral ischaemia. If you do not have hypertension or other risk factors like diabetes, smoking, high cholesterol or a strong family history of premature heart disease, you need not worry. If you are in doubt, you can do a treadmill test and 2-D echocardiogram. All these tests are needed only if you are in a vulnerable age (above 40 years) or have symptoms like chest pain, experiencing breathlessness, palpitation or exhaustion. Normally "Anterolateral ischaemia" alone is a very incomplete diagnosis to give an opinion.

* * *

Name withheld:

I am suffering from a cyanotic heart disease, tetrology of fallot, atrial septal defect of heart since birth. I underwent an operation for BT shunt that is presently functioning well. I am now 25 years old. Is it possible to correct these problems through surgery? If I get married, will I be able to withstand the strains and stresses of pregnancy?

Dr. P. Ramachandran replies:

Tetrology of fallot with ASD is a cyanotic condition. The fact that you have undergone BT shunt suggests that your congenital defects are quite severe.

It is very positive to note that your shunt is functioning well. However this is not equal to complete correction, which must be aimed at all people with tetrology of fallot.

Even with complete correction, marital life and pregnancy are safe only when all lesions are corrected fully. In incompletely corrected or with BT shunt, pregnancy is not smooth and cannot be recommended unless the current position of your defects of heart and feasibility of complete correction are assessed. Today, surgery for tetrology of fallot has grown tremendously and is highly successful.

* * *

Worrying about your skin

Name withheld:

My father developed leucoderma at 50 and my granduncle too was affected at around the same age. I am a 24-year-old girl and suffer from pigmentation marks and freckles on my face. I would like to use "fairness essences" to lighten the freckles but am apprehensive that it may lead to leucoderma. Kindly guide me towards a correct solution.

Dr. R. Murlidhar,

Dermatologist, replies:

Leucoderma or vitiligo is a common disease and affects almost three to four per cent of the population. Like all diseases, there are genes which control this disease also, but that does not necessarily mean that it is hereditary. As such, there is nothing much to worry about leucoderma as only a small, but conspicuous, percentage is resistant to therapy. So I do not think you should worry unduly about leucoderma itself.


Having said that let me come your specific question: by freckles, I suppose you mean flat, pigmented patches that occur on the face. These are usually very small. Many Indian patients have lentigenes, mistakenly called freckles because they may appear similar. Freckles require only sunprotection. However lentigenes do not disappear with sunblocks and avoiding the sun alone. They are best treated with a laser, which is far more accurate than a fairness cream. We see many cases where application of fairness essences or chemicals, which bleach the skin, has precipitated vitiligo. You also speak of pigmentation marks. You should specify why this has occurred. If it post-inflammatory i.e. following some inflammation on the skin, it may go with just sun protection and antioxidants. Sometimes chemical peels help.

* * *

K.S. Kannan, Coimbatore:

My friend has got allergic urticaria for the past three years. Skin tests revealed that he is allergic to house dust which is omnipresent. Administration of anti-allergic drugs, Altiva, Pericort, Terfed, Zyncet, along with about 10 immunotherapy Antigen injections in a space of one year proved to be of no avail. He has been taking one Cetzine tablet every day for the past two years. It gives him relief for 24 hours only. If there is any other treatment available to help restore his original health. Also, will taking cetzine daily cause side-effects?

Dr. R. Murlidhar replies:

Urticaria is common and is manifest by itchy wheals on the body. This may be accompanied by breathlessness in some patients or other systemic symptoms in a few. As such there is no major side-effect from using cetrizine in the long run, taken in correct doses. Some patients report drowsiness initially. We do have reports of patients having taken cetrizine for a few years without major problems. Some patients may have physical factors for the persistence — like pressure, sweating or cold, which stimulates the urticaria.

Underlying diseases of any system may be present. So your friend should get a thorough medical examination done. In patients who do not have any underlying cause for the urticaria, we have several newer drugs available which will give relief.

There are several tests that we use to determine the right approach in these cases. I do not use skin tests in urticaria as they are almost always difficult to interpret and yield a large number of false positives, which does not correlate with the clinical behaviour of the disease.

Immunotherapy injections may not always work. Last but not least, one should look for stress as a precipitant.

* * *

Neurological disorders

Name withheld:

My wife is 29 years old and we have a two-year-old son. Of late, my wife had a couple of seizures. We were married in 1999. Immediately after marriage, she had a seizure, which when we consulted a physician, was reported to be due to excess strain of the marriage. Her parents say that she never had a seizure before and there is no epileptic case in her family. After the recent episodes, I took her to a general physician who says that she is epileptic. The EEG was taken and it doesn't show any epileptic activity. My question is can epilepsy occur after so many years? The doctor says that she should not be allowed to exert herself mentally and physically and she should not be allowed to witness tragic scenes. The last two seizures had occurred when she was mentally down, I believe. Can epilepsy occur due to such causes?

Dr. Prithika Chary,


Neurologist and Neurosurgeon replies:

Epilepsy is a brain disorder, which can manifest itself at any age. The most common age of onset is 10 to 20 years of age. Again the incidence rises in the elderly. It can arise for the first time as a provocative seizure, i.e.the seizure has a definite provoking cause like prolonged sleep deprivation, starvation, undue physical or emotional stress, too much exposure to very hot sun resulting in a sunstroke, high fever (106{+o}F) and other such causes. The EEG is abnormal only in 70-80 per cent of frankly epileptic patients. A normal EEG is of limited diagnostic value. Also 30 per cent of normal people can show EEG abnormalities. Since your wife's seizures are stress induced, a neurological and psychological opinion might identify if it is a true seizure or not.

* * *

Krishna Kumari Menon:

My daughter, 25 years old, is suffering from the Lennox Gestant syndrome and intractable epilepsies. She is on the following medication: Sodium Valproate 10 ml, thrice a day; Rivotril, clonazepam 2 mg, twice a day and Lametrogene, Lametec 100 mg, twice a day. Inspite of this, she has two or three seizures everyday, especially when she is in the bathroom. She does not talk and needs constant care. She undergoes physiotherapy for an hour everyday. What is the best course of treatment for her?

Dr. Prithika Chary replies:

Lennox Gastaut syndrome is a very severe epilepsy of childhood, is resistant to usual drug treatment and is usually not suitable also for epilepsy surgery. As you have seen, it needs polytherapy with anticonvulsants. One of the drugs, which are useful to control seizures, is Vigabatrin, which is not freely available in India, and which you do not seem to have tried. Replacement of one of the present drugs or addition of Vigabatrin might further help in seizure control.

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