Recent results show that there is good prognosis after surgical repair. Life expectancy was normal. However, the chance of degenerative changes to coronary artery might be higher if there is persistence of dilatation of the coronary artery. In different previous studies, complete closure rates were seen in 50% to 100% patients. Your exercise capacity will be determined by recovery after surgery. If there was a stump after fistula, there is a risk of blood clot forming in the stump. If there was complete closure of fistula and there was no heart damage prior to surgery, your exercise capacity will probably not be affected .The atrial fibrillation that you developed after cardiac surgery might be a transient phenomenon with no long term effects. Keep an eye on your heart rhythm from time to time.
If your father does not have any breathing difficulty while sleeping, it is less likely that it is related to heart or lung problem. Agitation or breathlessness at rest can be due to anxiety or worsening of dementia. I cannot explain why he has breathlessness only while resting and not while sleeping.
From the information provided, it appears that you have multiple risk factors for cardiovascular disease. The presentation of angina in diabetics can be atypical. Diabetics are more likely to have significant coronary heart disease. The symptoms should not be taken lightly. Neglecting the symptoms might lead to potentially dangerous consequences. I strongly recommend that you immediately visit a doctor before it is too late.
Blunt carotid and vertebral artery injury also known as blunt cerebro-vascular injury is extremely rare. Motor vehicle accidents are the most common cause of blunt cerebro-vascular injury. One can develop blunt cerebro-vascular injury with simple chiropractic manipulation, increased movements of the neck up or down during hair washing, “head banging” to music, “bottoms-up” drinking, rapid head turning, basically any significant movement of head. Blunt trauma can damage inner lining of blood vessel known as intima which can lead to clot formation. The clot can subsequently go the brain. you should consultation wiht a neurologist.
What you describe appears like a condition called Raynaud phenomenon. This is an exaggerated response of blood vessels to cold temperature or emotional stress. In your case, either stress or cold weather might be causing blood vessels in the big toe to decrease in size which in turn leads to decreased blood supply thereby causing toe to turn blue. When you warm up, blood vessel comes back to normal size and recovers its normal shade. There are multiple conditions like scleroderma, systemic lupus erythematosus, other connective tissue diseases, occlusive vascular disease, drug effects, hematologic abnormalities, and use of vibrating tools which can cause Raynaud phenomenon. I recommend that you visit your primary care doctor so that work up for Raynaud phenomenon can be done and the exact cause can be identified.
Angiography was indicated when you were having heart attack. After the acute episode had passed, opening up the closed coronary artery will not recover the dead heart muscle. So angiogram may not help at this point. However stress test will give information whether other coronary vessels are diseased. If stress test is positive, then an angiogram is needed to open up affected coronary vessel. Further more after heart attack, pumping capacity of heart decreases. So it is very important for you to take right medications which will help improve pumping capacity of heart and prevent you from getting heart failure. I recommend you to continue to follow with a cardiologist for further management.
Typical presentation of anginal chest pain would be chest discomfort or tightness( not sharp type),brought on by exertion, and improving with rest with radiation to shoulders, jaw, or inner arm. In a study looking at patients under age 40 who presented with heart attack, 80 percent smoked cigarettes, 40 percent had a family history, 26 percent were hypertensive, and 20 percent had hyperlipidemia It is highly unlikely that the sharp pain in someone as young as you would be heart attack related unless you have most of the above risk factors. It appears that the symptoms are more likely due to anxiety. However coronary vasospasm is common in women and cigarette smoking can make it worse. I advice you to stop smoking if you can.
What you describe appears like premature atrial or ventricular beat. EKG may be normal when you are not having these episodes of catch-up beats. Holter or an event monitor will provide information about whether these catch-up beats are actually premature atrial or ventricular beats. It has been reported that prevalence of premature atrial beats among patients with mitral valve prolapse varies widely from 35 to 90%. If holter monitor does demonstrate that these are premature atrial or ventricular beats, I would recommend you to stop any potentially exacerbating habits like caffeine intake, alcohol intake, smoking and stress. Premature atrial or ventricular beats are relatively benign and do not cause life threatening abnormal rhythms.
In a condition called inappropriate sinus tachycardia, patients tend to have elevated resting heart rate and/or an exaggerated heart rate response to exercise. This is different from condition called postural orthostatic hypotension syndrome where patients tend to have normal baseline heart rates and exaggerated sinus tachycardia in response to changes in posture. Tilt table study to rule out postural orthostatic tachycardia syndrome can be performed. Increased heart rate might be due to suddenly standing up, but it is not clear why you do not have symptoms when standing during the day or when you are getting up in the morning. sometimes atrial arrhythmias that arise from the right atrium can look like sinus tachycardia and an electrophysiologic testing may be necessary to determine the exact nature of this arrhythmia.
Both CONCOR and valsartan have been shown to be beneficial in CHF. The combination of beta blocker and calcium channel blocker would slow down the heart rate. In your case, if your symptoms are not controlled with present dose of medications, it might be worthwhile increasing the dose of medications since the pacemaker would prevent the heart rate from dropping to very low heart rate. The other option would be radiofrequency ablation. Post maze atrial flutters can sometimes be challenging but most of them can be successfully treated with mapping and radiofrequency ablation. Contact an electrophysiologist who specializes in complex arrhythmia ablation in your vicinity and seek consultation. You have not been tried on other antiarrhythmic drugs like Dofetalide or sotalol which are worth looking into.