### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
my grandmother has been admitted into a hospital for cellulitis and doctor found out she has a enlarged heart, however she already has highblood pressure also is diabetic which she dose take Meds for she s had a couple of heart attacks in the past about 2 decades ago pluse I believe 1stroke, after all she has been through she is very alert, she walk, bathes her self, and still shows to be very strong, she s is early 80 s of age, I know she s still alive and shows to be well with it be cause her faith in God through our Lord and Savior Jesus Christ, however I just wanted to get some info of the enlarged heart with skipping heart beats situation..

### output:

Hi. Welcome to Chat Doctor. I understand your concern. First, I would like to recommend some tests for this diagnosis. It would be reasonable to do an echocardiogram, to assess the movement of heart muscle, to confirm or exclude a recent or remote heart attack as the main cause for this heart enlargement, as well as to assess the functionality of the heart valves. Furthermore, I would recommend a series of blood tests, such as cholesterol, triglycerides, renal function tests, liver function tests and electrolytes. From the symptoms and fitness you describe, she is probably in heart failure, class II of the NYH (New York Heart Association) classification system. Since the damage to the heart is now factual, I would recommend starting her on treatment with furosemide (Las ix) 40 mg x 1 tb/d and April 2.5 mg x 2 tb/d. If April is counterindicated, then she can start on losartan 25 mg x 2 tb/d. This is added therapy, while I assume she is on proper medications for established diagnoses. Also, I would recommend that she should a diet free of salt. About the skipped heartbeats, she should be put on a 24-hour Holder rhythm monitor, to establish if these events are dangerous and how often they happen during a day. Then, you can consult her cardiologist whether to start also on amiodarone 200 mg x 1 tb/d, or not. I hope I was helpful with my answer. Take care.