Patient questions cardiologist’s methods

DEAR DR. GOTT: I learned I had mitral-valve prolapse (MVP) about 40 years ago and have had it monitored ever since. I am now 65 and otherwise healthy. I have always had spells where my heart would start beating real fast, but they have been more recent lately, occurring almost once a month.

About four years ago, my cardiologist put me on 20 milligrams lisinopril daily. My blood pressure is 135/80. Since then, we moved from California to Arkansas. Last month, a new doctor took me off lisinopril and prescribed 60 milligrams diltiazem twice a day. He referred me to another cardiologist. The new cardiologist wants me to start taking 240 milligrams Pradaxa instead and suggested I undergo valve repair ASAP.
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Daily Column

DEAR DR. GOTT:
I am a 79-year-old male in reasonably good health for my age.

Many years ago I was diagnosed with mitral valve prolapse. It does not give me any trouble, unless it is somehow connected with my other problem. I have been diagnosed with air hunger.

Occasionally I have the sensation of a shortage of air in my lungs. This causes me to cough suddenly and take several deep breaths to relieve the feeling. I have never smoked and over the years have had several normal chest X-rays. A stress test also showed no abnormalities.

My doctor has prescribed Ativan and Buspirone daily. These seem to help somewhat but are not a cure. The problem intensifies when I have a cold and at other times for no apparent reason. This has been occurring for many years.

DEAR READER:
Air hunger is a respiratory distress condition. It is marked by labored breathing, difficulty breathing and/or the feeling of not getting enough air into the lungs. It can be very disturbing when it occurs. It is not related to mitral valve prolapse.

Your physician appears to have taken appropriate first steps in testing. I believe the next step should be a CT scan or MRI which shows more detail and may pick up an abnormality previously missed. Lung masses, cancer and other conditions need to be ruled out before you can be definitively diagnosed with a benign condition.

I would like to mention that since you appear to be responding favorably to Ativan (an anti-anxiety drug) and Buspirone (a tranquilizer), your air hunger may simply be a manifestation of a panic disorder. Perhaps a psychiatrist or therapist would be the appropriate next step to take.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure mention the title.