<s>[INST] Hello doctor, My mother, aged 64, has ischemic cardiomyopathy. Her angina and breathlessness are reduced, and they only occur when she exerts herself. But, she is feeling nauseous and dizzy even though she takes food every two hours. Her random blood sugar test is done, and the values are between 41 and 51. We then give her some sweets. This is happening even if she does not take any blood sugar medicine. Her blood pressure is 86/60. One and a half years ago, she got a heart attack. She got an angiography done, which showed triple vessel disease and two blocks. The doctor suggested her to have a CABG. But, we did not go for this as the patient was not willing. She did an EECP for 35 days, and this helped her a lot.She was able to lead a normal life for a few months, and then the pain started getting bad again. She started getting water retention and breathing problems a year ago. We took her to a cardiologist who prescribed her the following medications. She has been on them since a year. She is on Aztogold, Angiplat, Nicoduce, Vogli-gm 1, Exenta T 20, Cordarone 100, Vymada100, Synx 500, Carvidon-OD, Zyloric for 10 days, Thyronorm 12.5 mcg, and D-Shine once a week. In the past, she has been on Ecosprin, Atorva, Nikoran, Clopitab, Myonit, and Sorbitrate. A 2D echo done three days ago shows an EF of 35 % to 40 %.She is diabetic. Her fasting blood sugar is 87, and her postprandial blood sugar is 104. Her HbA1c is 8.2, her TSH is 11.27, uric acid is at 8.5, and her vitamin D is at 10.41. She is currently prescribed the above-mentioned medications, and I want an opinion about this and a suggestion for further treatment. Even though she has not taken the Vogli-gm 1 for the past two days, her random blood sugar level is very low at 40 to 50, and she feels dizzy and weak. I am not sure what is causing this. Any advice on this would be helpful. [/INST] Hello. Well, your mother seems to have issues with her blood sugar and thyroid together along with the heart problems. This makes a vicious circle leading to symptoms getting interrelated thereby creating a worse scenario. She is having high TSH (thyroid-stimulating hormone) levels that can either be due to underworking of the thyroid gland or from some issues with the pituitary gland (a small pea-sized gland that plays a major role in regulating vital body functions) or the hypothalamus (a small area in the center of the brain). She should consult her physician to adjust the dosage of medications that she is taking for her thyroid issues. I would recommend you to take her to an endocrinologist for a better input in this regard. Although angioplasty and stenting would not be beneficial to her, you can consult her cardiologist in this regard. Her vitamin D levels are low. Try to take her outside for a little walk or at least just sitting in sunlight. This will help regulate her vitamin D levels if there is no issue with her liver and kidneys. Apply sunscreen to avoid any sunburns that may happen. Hope this helps. Please feel free to let me know if you need any further assistance. I would be happy to assist. For more information consult a cardiologist online --> </s>