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St. Jude Medical

January 21st, 2018
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Hello doctor,,my grandmother had surgery to remove cancer about 50 days ago.Recently she suffered cardiac arrest and quit breathing and her heart quit and she stopped breathing. They didn't have anything for 30 minutes but finally got her back. They say she has some brain damage, heart damage, broken ribs, dislocated sturnum, a bad infection (white count at 27), high temp and still has cancer.How much brain damage has been done and do you think she will have any quality of life? Thanks Hello doctor,,my grandmother had surgery to remove cancer about 50 days ago.Recently she suffered cardiac arrest and quit breathing and her heart quit and she stopped breathing. They didn't have anything for 30 minutes but finally got her back. They say she has some brain damage, heart damage, broken ribs, dislocated sturnum, a bad infection (white count at 27), high temp and still has cancer.How much brain damage has been done and do you think she will have any quality of life? Thanks
2013-09-03 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

I am very sorry to hear about your grandmother. This is a very difficult question - and only time will tell. It sounds like the team did a great job of bringing her back. In these cases, I've see a wide spectrum of response. I would discuss this with her medical team there. Thanks.

Hi Doctor,I am 53 yr old Indian business man.I was on alcohol & tobacco.While selecting medication liver & kidney. Other minimal side effect medicine therapy to treat hypertension,ANGIANA,atrial fibrillation & cholesterol & incresed circulation.
2013-09-03 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

With these factors, I recommend you have a full evaluation by a cardiologist who can advise you on specifics related to your particular condition. It seems that you have stopped using tobacco and excessive alcohol - that is excellent. Thanks.

Thank you Dr. for your reply. The reason I asked is because I am trying to understand what\'s going on. It seems to me (I\'m an electrician) that Afib is a symptom of a digestion problem and if you fix the digestion problem you fix Afib. I reasoned that the trigger must be via the vagus nerve and if you isolated it from the heart you stopped Afib. I thought that\'s what you did when you preformed a PVI ablation. Is that too simple?
2013-08-28 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

That is a nice theory! Some of what you are saying is part of our mainstream of science - that the vagal nerve can trigger AF. However, other portions are less clear - that PVI essentially works primarily by eliminating this trigger. At this time, while the nervous component of AF is likely important, we don\'t have final answers to what ablation does in any one patient. In our work, for instance, ablation worked primarily by eliminating rotor areas. Upcoming work will try to address these excellent questions.

Dear Dr Narayan, I\'m a 69 year old male, had a successful AF ablation late last year. PVI using cryo. In July I presented with complex atrial flutter. Had a successful cardioversion after 23 hours of flutter. Ten days ago I had ablation for the flutter using RF. Three circuits and one focal point were found and treated. Three questions: Is this many flutter motors unusual? I\'m told that AF episodes often happen during the healing process after AF ablation due to \"cardiac irritability\" and will eventually subside. Can I expect minor flutters during the flutter ablation healing process? I\'ve read that propafenone will slow conduction and possibly set up conditions favorable to flutter. Is this therefore not an appropriate med for post flutter ablation treatment? Thank you.
2013-08-27 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

These are excellent and well-informed questions. Yes, in the first 3 months after an AF ablation the heart heals and may give rise to AF or even \"flutters\" that often go away. For arrhythmia recurrence at this stage, more than 6 months after the procedure, ablating the flutter(s) was very appropriate and I\'m glad that it went well. It may be that you don\'t actually need drug therapy if the flutter ablation was successful. Drug management at this time is very person-to-person specific, and depends upon your heart health and overall state of health. While propafenone can sometimes make flutter worse, it can also be very useful in other patients. Your treating physician is the best person to make this decision with you. Best wishes

Hi Doctor Narayan, when you do a PVI ablation do you isolate the vagus nerve.
2013-08-27 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

This is an excellent question. In fact, several studies have shown that the process of PV isolation itself actually tends to isolate some special nerve endings in the heart called ganglionated plexi (or plexuses). Thus, after PVI, these GP are often already modulated. Some groups do additional modification of the GP, but they are difficult to identify based on traditional methods. The approach in my laboratory is somewhat different, and involves ablating the regions driving AF called \"rotors\" in a procedure called FIRM. These rotors are located throughout the heart, typically 2-3 per patient. Thanks again for your question.

Iam a 52 year old female . I've had a blood test come back with iron levels abit high,i went to a cardioligist due to high cholestorol 6.4,heart disease is on both sides of my family.There is asmall amount of calcium in my main artery that has come back from having XXXXXXX pit into my veins,so as u can imagine i am rather concerned. Thanks.
2013-08-19 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

This is a very topical question - thanks. Your family history of high cholesterol, and calcium in your heart artery are both important pieces of information. .The iron levels you quote are interesting, but not directly related to blockages of the heart arteries. However, you should see a cardiologist about this. Even more important than what you have written are whether you feel symptoms of chest pain, chest pressure, arm pain, shortness of breath or other symptoms when you exercise. If so, or if have any untoward symptoms, you may need additional work-up including stress tests, heart scans or other tests. You are definitely going about this the right way, and a visit to a physician who can "put all the information together" will be helpful.

Hi Doctor,I have been struggling a fatique and lack of appetite problem since couple of weeks.I have been checked in an ER 4 times in the last month and all test results are normal.I recently started seeing a cardiologist and got an echo done and kidney arteries sonogramed. I am ready to check into a phych hospital tomorrow and was wandering if the ER's could pick up if I am in beggining stages of heart failure?
2013-08-19 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

Thanks. You have done the right thing to get a series of tests and relevant medical opinion. Your worry about "heart failure" is something that you should ask your cardiologist about immediately. Based on your symptoms, your physical exam and your echocardiogram, he/she should be able to tell you Yes/No with some certainty. After that, therapy may change. Your hospital admission is also a time when, typically, other investigations could be performed to save time. Please mention this to your medical team at the hospital, and have them contact your cardiologist (and other doctors) to get all the information on you.

I am a 26 year old male 6ft 230lbs. A couple yearrs ago i was taken to the hospital by paramedics who thought i was in cardiac arrest but hospital diagnosed me with heart palpitations. To this day atleast one to two times a day my heart races and i get weak feeling and disoriented. I can even see my heart beat through my shirt and during the spells blood pressure is average of 135/100 but goes back to normal after the spell. I also have been getting botox the last 9 months for mild cervical dystonia and migraines. Is this heart situation normal?
2013-08-19 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

Thanks for your question. If you are getting "a weak feeling and disoriented", then this is not normal. However, it is not clear from your account what is causing this. It could be your heart "Palpitations", but it could also be several other things related or even unrelated to your heart. This is a time when going to see your doctor, and your cardiologist will be very useful. He/she can then do some monitoring, including an ECG that you wear hopefully during times of "palpitations" to see what they are. Based on this, and other tests, they can decide what the right therapy is for you.

Hello Doctor,I am 64,My BP and other vitals are fine.But I had a defibrillator put in 2 yrs ago after a TIA Nothing has ever happened since then Should I have it removed I had a defibrilllator put in 2yrs ago after a TIA as they found my heart beating too slow. I ve gone thru all the monthly checks and never once had a sense of this kicking in. Maybe the doctors were too fast to put it in. Should I have it removed. Suggest me,Thank You.
2013-08-19 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

This is becoming quite a common question. In my opinion, if the original reasons to place the defibrillator were sound, then the defibrillator should not be removed and should be replaced when its battery is low. This is based, among other things, by data that (a) the first (lifesaving) defibrillator therapy can be years after implant and (b) the risk for life-threatening arrhythmias does not necessarily go away even if your heart function improves over time. Thanks for this interesting question.

Dr. Narayan, I have a research question. Apparently many conditions of old age are now believed to have inflamation as an underlying cause. Have you looked at the tissue in the atria where you see rotors and other AFIB evidence to see if there are any signs of inflamation? Thank you.
2013-08-13 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

This is a super question. We are working on this now. What we do know, however, is that rotors are not always at sites that are traditionally targeted, such as sites of fractionated electrograms or low voltage, and may lie widely within the atria. Watch this space for more updates!

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