Questions by Doctors for Better Doctors

shogunly · #1 11-25-2007, 07:38 PM

Hello
I am a medical doctor and I frequently think of questions I cant find answers for in medical books (at least the ones I have) so I thought experienced MDs who are also users on this site might like to offer help . Here are some questions I would love to get answers to :

1. Steroid related myopathy vs Cushing vs Polymyositis
I have encountered a case of muscle wasting disease that had been diagnosed as polymyositis . The patient had gradual loss of muscle power over years and had corresponding high levels of muscle enzymes like CK in blood . The onset is in late 50s which is incompatible with inborn defects .
Anyway this patient was started on the standard therapy for this condition i.e. STEROIDS (plus azathioprine)
The patient was advised to get a new blood enzyme assay after 2 weeks of beginning the high dose steroid course to assess the response to treatment , usually manifested by a drop in blood levels of muscle enzymes . So when the assay result came back , there was a twofold increase in the enzymes , meaning the steroids actually increased the muscle destruction process .
My question is this
Could Cushing disease be the cause of this woman's myopathy ? (by the way she was examined by endocrinologist and endocrine disease was excluded ) Could Steroid induced myopathy be the ONLY presentation of Cushing disease ? I thought of that because if the disease was inflammatory in nature , then steroids should have DECREASES the destruction and the enzyme levels in blood . Waiting for the reply of a good endocrinologist

2. Exercise and lung function
It is known that during exercise one of the adaptations is that the pulmonary vasculature is expanded by the increase in cardiac output . Also it is common knowledge that some chronic lung diseases like Asthma and COPD ultimatley associated with increase in pulmonary vasculature resistance (pulmonary hypertension) ansd then progress to right ventricle hypertrophy and right heart failure or Cor Pulmonale .
Question
Could that gradual onset of pulmonary hypertension be related to the fact that asthmatics and COPD sufferers are less likely to exercise regularly , thus there is no periodic (expansion) of the pulmonary vaculature , which causes it to shrivel and become less compliant , causing high pressure and more load to the right ventricle ?? In other words , could regular exercise be therapeutic and prophylactic for pulmonary hypertension ?

3. Hypovolemia signs and consequences
One of the cardinal symptoms of hypovolemia is dizziness with low blood pressure on examination or postural hypotension . But there also is a sensitive sign which is tachycardia related to posture . So hypovolemia either due to dehydration or bleeding will lead to a compensatory increase in heart rate .
My question is this :
Could arrythmia accelerated heart rate be a presentation for hypovolemia ?
Like , could someone with dehydration or blood loss die from VTach for example ?

THANK YOU

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