Q: I have been diagnosed to be suffering from Eisenmenger's Syndrome. Let me quote from the case history prepared by MIOT hospitals, Chennai. Brief History: Detected to have atrial septal defect with PAH in May 1999, while being investigated for excretional dysponea. Advised medical management after cardiac catheterisation. Echo (04/07/02): EF 50% ASD. Left to right shut, moderate PHT. Physical examination: thinly built female. GC: Good. HR: 78/Min, BP 110/80 mmHg. RS: NVBS+, CVS: S1 S2+. Gr: 2/6 SM heard over left sternal border. ABD: Soft BS+, NS: No deficit. Investigations: CXR: No cardiomegaly, normal lung fields. ECHO: Severe PH. Large ASD. Eisenmenger's syndrome. Recommendation: - Cap Nifedepine 5 mg 1 - 0 - 1. to be continued. - Intermittent Oxygen inhalation. - Surgery not possible. I weigh only 34 kg and cannot climb even a slight slope. I lose my breath quite often. Intermittently my pulse rate goes quite high and after vomiting I get back to normal. Now for the last one year I am undergoing homeopathic treatement. Will I be able to lead normal life? Please help.

A:As you have already had a cardiac catheterisation there is no need to test further if you are operable. In Eisenmengers the small blood tubes in the lungs get damaged increasing the pressure on the right side of the heart which pumps blood into the lungs. Sildenafil is a drug that has been tried in Eisenmenger with good symptomatic benefit in some patients. You may consult your doctor for a trial of this drug. Anticoagulants to prevent blood clotting are also prescribed by many doctors if your clotting parameters are normal. Nifedepine in higher doses also may help but is general no drug is curative or provides significant symptom regression in Eisenmengers. Pregnancy is absolutely contraindicated and very dangerous in Eisenmengrs. You have to restrict your activity if you are feeling breathless or giddy with it. There is a lot of research into drugs that lower pressure in the lung blood tubes & in the near future there may be good news for people with Eisenmenger's.