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July 07th, 2015
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I am a 72 year old mail with a 6 year history of afib. Three months ago I had my fourth catheter ablation. Since then I have not had any occurrences of afib. I have had an increase in PVCS and bloating. Could these be related to the abalation and to each other. Thank you
2012-11-28 Answered By : Dr. J.David Burkhardt M.D., F.A.C.C. F.H.R.S.

We do sometimes see an increase in PVCs after ablation for a fib. This may be due to the nerves around the heart being affected. In general, we perform a 24 hour monitor to evaluate how many PVCs are present in 24 hours and an ultrasound of the heart to evaluate the pumping function. Bloating can have many causes including from the PVCs, particularly if there are a great deal of them (20,000 or more in 24hours). Ablation can also damage nerves that help the stomach empty. It may also be unrelated.

Hi Doctor, I'm a 40 year old male with paroxysmal afib. I was diagnosed in Aug 2009 and have been getting 2-3 episodes per year that convert quickly with Propafenone PIP. After my last episode in Sept my heart has been very jittery and I have been getting way more ectopics than normal which will flip to afib if I don't stand up and get my HR up. If they do flip to afib I can always convert it back within 1 minute by a valsalva manouver or by running. All confirmed on a holter monitor. My EP suggests that if I want I can start using propafenone 150mg twice daily along with diltiazem 180mg. I don't like the prospect of taking antiarrhymics for the next 30-40 years and I was wondering if I was a candidate for ablation. When I take the 600mg of propafenone PIP I feel likeI'm going to die, it's so bad. My EP says his protocol says since I must fail on at least 2 antiarrythmics first I'm not a candidate in Canada. So if I did I would go to Bordeaux. What do you think? Is ablation a viable option at this point? I want to stop this before it gets worse (ie. persistant)
2012-11-28 Answered By : Dr. J.David Burkhardt M.D., F.A.C.C. F.H.R.S.

I think there are two different questions listed in three. For the first, If you have failed an anti-arrhythmic medication, which includes not being able to tolerate the symptoms caused by the medication, then you would be considered an ablation candidate. Insurance companies and other countries may not pay for the procedure unless you meet other criteria. For the second, there are many factors that can cause an elevated heart rate. Anemia is one. High thyroid, dehydration, stress, pain, are just a few of the others. A 24 monitor is not unreasonable if you have had a good evaluation for the most common causes.

Hello Doctor,The other evening, after a spell of feeling drowsy, I was at work at my desk, feeling no particular stress or pressure, when my pulse was suddenly elevated and stayed elevated for about 15 minutes, with a strong sensation, somewaht painful, of throbbing in the throat. I had no other symptoms--no dizziness , no mental confusion , no chest pains. I am 68 and never before experienced such an incident. I am generally in good health, I exercise every day, and my only med is an ace-inhibitor for BP. I drink two glasses of wine at dinner.
2012-11-28 Answered By : Dr. J.David Burkhardt M.D., F.A.C.C. F.H.R.S.

I assume your question is what are the possible causes of your symptoms. Arrhythmia is likely. The symptoms in the throat are sometimes seen more with a rhythm such as Av node re-entry but other rhythms such as a fib are also possible. I would suggest having an event monitor if you continue to get such symptoms, or if it lasts long enough, getting an EKG done at an ER or physicians office.

Hai Doctor,HI my trigycerides are 475 and total cholestrol 279.. Though I have high trigycerides for years now , cholestrol is a recent development. ( 1 yr back). I haven't taken any medicine as yet. I get my stress test done every year and it has always been normal. I Run about 6-7 km each day for 3 days a week and do weight training 2-3 days a week. I have now been advised Rozavel F for life.. Is it right to take medicine for life. I am 35 yrs old.
2012-11-28 Answered By : Dr. J.David Burkhardt M.D., F.A.C.C. F.H.R.S.

I am not really a lipid expert, but in general, I believe that if someone has elevated cholesterol despite optimal lifestyle modification and removing aggravating factors(such as medications that elevate cholesterol) then medical therapy is warranted.

I am 47 yrs old, very active cyclist now for ~5yrs (cycle intensively for 1.5 hrs/day, 2 days/wk). Over past 6 months, I have had lone PAF, diagnosed ~2months ago. I was put on dronedarone (Multaq), which failed to prevent further episodes. Instead of trying another drug or ablation at this point, I have elected to stop intensive exercise, alcohol, caffeine and see what happens. If I can get back to pre-medication situation, where I had episodes 4-6 weeks apart, 5-15 mins duration, I'm ok with that. What is my risk of the disease progressing under this scenario, versus if I were to try a different medication? This seemed the biggest concern of my EP. Is there evidence that more episodes accelerate remodelling of the heart? Is ablation the only route to returning to my intensive exercise and occasional use of alcohol and caffeine?
2012-11-28 Answered By : Dr. J.David Burkhardt M.D., F.A.C.C. F.H.R.S.

In general, I consider afib a progressive disease. It tends to occur more frequently and last longer over time. The amount of time this takes is the major difference among people. For some it is many years, while for others it may only be weeks. The goal of treatment of afib is to allow you to live life the way you want to live it without symptoms interfering. Avoiding bad habits such as excess alcohol, drugs, or a poor lifestyle is reasonable, but physicians would like to you to enjoy exercise and caffeine and the occasional wine. For a young person without heart disease, I would consider therapy with Flecainide. It tends to work well with fewer side effects. If this fails, then consider ablation. The time to consider ablation is after failing medical therapy, when you feel that the symptoms warrant further treatment understanding the risk of the procedure. The only caveat to waiting is that if you do transform to persistent a fib (meaning you require medications or a cardioversion to stay in rhythm, the success rate of ablation is diminished.

Hi doc, I started getting this problem about a year ago and recently itís been happening a lot more often. Itís like, when I breath in, there is a sort of painful popping in my chest to the left, where my heart should be. I feel it coming on and when I breathe in it sort of pops with pain and then goes. This is happening 5-6 times a day and has been getting worse recently. Iím not sure what it is but I donít know whether to be worried or not. Please help me?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

It is not clear why you have popping sensation when you breathe in. If the pain or popping sensation increases with taking deep breaths, not associated with sweating, dizziness and not related with exertion, it is unlikely that it is related to heart. It could be either be musculo-skeletal pain (related to muscles and bones in the chest region) or a condition known as costo-chondritis. Treatment will involve taking anti-inflammatory medications like ibuprofen as and when needed. If the pain continues to recur, I would recommend you to follow up with your primary care doctor.

Hi doctor I'm a 64 year old female who had open heart surgery 4 weeks ago, mitral valve repair, aortic valve replacement, double bypass, and a Maze procedure. One week later, I had a pacemaker put in. I was recovering nicely until one week ago when I got the flu. That lasted for about 4 days, but I am now having terrible stomach issues. I can't lay down. My stomach is bloated, it makes breathing difficult. I haven't had an appetite since the surgery so I'm eating very little, bowel movements are very limited. Last night I started with pain in my esophagus. I am totally miserable. I'm wondering if I might have GERD, or if this is something that I should speak to my cardiologist about.
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

The symptoms that you have described are not known side effects of influenza. It is not clear whether you are taking any pain medication like morphine which can cause abdominal distension, flatulence, GERD. Symptoms do not appear to be related to heart. Since you are having symptoms within 4 weeks surgery, I suggest you speak to the primary care doctor.

Hello Doc, I am 25 year old, I have a heart condition, had 2 open heart surgeries now but before a got the ops a done weightlifting and basically am looking to find out if protein shakes are a yes or no thing now that a have my condition! I am 25 about 6ft weigh approx. 16st mostly muscle my op was replacement of the aortic valve now I have a titanium valve there and on warfarin all my life. So basically can a take the protein shakes or anything like that for that matter? Answer: Following are the list of herbal supplements that interact with warfarin : cranberry, fenugreek, ginkgo biloba, glucosamine, alfalfa, anise, bilberry, bladderwrack, bromelain, cat's claw, celery, chamomile, coleus, cordyceps, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng (Panax), ginseng (Siberian), grapeseed, green tea, guggul, horse chestnut seed, horseradish, licorice, omega-3-acids, turmeric, prickly ash, red clover, reishi, SAMe (s-adenosylmethionine), sweet clover,and white willow. If the protein shakes that you intend to take contain any of the above, be aware that they can interact with warfarin and alter INR levels.Hello Doc, I am 25 year old, I have a heart condition, had 2 open heart surgeries now but before a got the ops a done weightlifting and basically am looking to find out if protein shakes are a yes or no thing now that a have my condition! I am 25 about 6ft weigh approx. 16st mostly muscle my op was replacement of the aortic valve now I have a titanium valve there and on warfarin all my life. So basically can a take the protein shakes or anything like that for that matter?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

Following are the list of herbal supplements that interact with warfarin : cranberry, fenugreek, ginkgo biloba, glucosamine, alfalfa, anise, bilberry, bladderwrack, bromelain, cat's claw, celery, chamomile, coleus, cordyceps, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng (Panax), ginseng (Siberian), grapeseed, green tea, guggul, horse chestnut seed, horseradish, licorice, omega-3-acids, turmeric, prickly ash, red clover, reishi, SAMe (s-adenosylmethionine), sweet clover,and white willow. If the protein shakes that you intend to take contain any of the above, be aware that they can interact with warfarin and alter INR levels.

Hello I am rohith, 30 year old. Currently I am under the treatment of hypertension and daily taking blood pressure tablet(Pin Om 40 mg) but since I am taking this tablets I am feeling tired, fatigue , dry mouth mild hand shaking and feeling of body shaking from inside. I have consulted with my family doctor but he has refused to change my medicine and told me it will go away after exercise. But currently I am not feeling well with this, please help me to avoid these problem and how can I reduce this problems.
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

Hi Rohith, the generic form of medication you are taking is a combination of olmesartan and hydrochlorthiazide. The medication hydrocholrthiazide is a diuretic which means it causes urinary loss of water and sodium. Therefore fatigue and tiredness could be due to fluid depletion. I recommend you to change the medication if you have intolerable side effects. Since this medication causes dehydration , take adequate amount of fluids every day to keep yourself hydrated. I hope as the first step towards blood pressure control, you have cut down salt in your diet. Daily exercise also helps in blood pressure control (Try getting at least 30 to 60 minutes of moderately intense physical activity most days of the week. You can even break up your workout time into 10-minute sessions)

Hi doctor I have been uneasiness in the left side of my shoulders chest and arms for some times I guess I took a supplement with high doses of caffeine and now when I consume caffeine the pain the heart increases it does not effect daily life and also when I am in stress my heart beat increase I never experienced these problems before the supplement.it will be helpful if anyone can provide the information about this?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

The increase in heart rate is due to stimulation of sympathetic nervous system by caffeine. To identify the exact nature of chest discomfort , more information of chest discomfort/apin, type , any radiation, association with exertion, any sweating , dizziness with chest discomfort is needed. Also information about family history of heart disease, age, risk factors like hypertension, diabetes, smoking, sedentary lifestyle is important to assess your risk for heart disease.

No.of Questions Asked in All Sessions: 1005
No.of Questions Answered in All Sessions: 1004

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