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May 28th, 2015
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Hi. I am a 52 year old male, I have just had a surgical repair of a coronary artery fistula that began on the right coronary artery and terminated in the right ventricle. I have been an athlete all my life. Will my athletic endeavors be limited? Never smoked and have remained in relatively good physical condition. After the surgical repair, I had some A Fib for a day or two, but that has subsided completely. I hope to be able to return to competitive sports when I have fully recovered. My blood pressure is excellent, resting heart rate of 72. It has been 3 weeks since my surgery. I have no abnormal pressures, no enlargement or heart muscle damage. Could anyone provide information about this situation..?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

Hi, my father suffered a stroke 2 years ago and has no movement in his left side he also has stroke related dementia. Recently he is very breathless at rest, but breathes OK when he is asleep. Our family GP thinks this is related to anxiety dad is already on medication for depression but I am not convinced. He also had a triple heart bypass ten years ago, has a pacemaker and pre-stroke suffered from blood pressure problems?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

I am experiencing slight throbbing pain in my heart. I am diabetic and am on insulin. I am a mild smoker. I do not deal. I take a lot of stress in my work. The pain is there for some time now for around 3 days. There is a slight tightness also that I experience. I do not feel sleepy and sleep very less. All my family is very tense. They are asking me to go to a doctor. However, I have very important work that I need to attend to. I want to keep things till I visit a doctor which I have planned tomorrow evening. Any first aid solutions currently. Please suggest me?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

Can a perfectly healthy 35 year old woman suffer a blunt trauma stroke, that is associated with severe blood clotting in the curative artery, followed by a blood clot going to her brain, merely by cocking and/or turning her head to pop her neck, or would it more than likely take more force to cause that? Please help?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

I am a 39 year old woman with no personal history of cardiovascular disease and blood pressure in the normal range (but my father has had several heart attacks, TIA s, and one major stroke that occurred while he was having an angiogram- left hem; approximately Brocas area). I recently began a full-time college teaching position, and have begun suffering acutely from occasional stress-related insomnia, combined with lack of sleep simply due to work load this seems related to other symptoms that seem like panic attacks, along with the general (sometimes intense) discomfort that goes along with fatigue. In the last few weeks I noticed that sometimes my left big toenail becomes blue, but it recovers its (more) normal shade after I rub my feet and legs or warm up in the shower. Could this be a sign of cardiovascular attack?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

HI. When i was on my routine works i was feeling little pain and my friends admitted me in nearby government hospital there i was treated for heart attack and then i was recommended for angiography as i have to spend from my pocket for the treatment for which i am not able by financing is it necessary to go for an angiography and then to follow the treatment for the same. It will be helpful if anyone can provide the information about this?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

Hello Doctor. Myself Nitya 22 year old female, mild smoker, with high anxiety , lately i have been having a dull pain where my shoulder meets my chest , sometimes the pain is sharp and goes down to my fingers other times it is dull and makes my fingers go numb, could this be a sign of heart attack or heart problems? Please help?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

Hello Doctor I am experiencing, over recent days, three incidents of painful heartbeats that feel strong and hurt a bit. Previously, I've had the occasional "catch-up" beat, when carrying something heavy upstairs or exercising a lot. I have two slight valve prolapses, mitral valve and tricuspid. One of them is minor, the other shows some regurgitation on an ultrasound, but all else was well on an EKG and an ultrasound a few months ago. Now-I'm having a 1) series of hard, somewhat painful beats, perhaps 10 in a row before they stop. These seem to have occurred on days on which I was tired. I drink one cup of coffee per day-the beats can be many hours later. Am losing weight slowly and carefully over recent weeks, with my usual moderate exercise, have taken off 8 pounds or so in the last month. Should I be concerned? Thank you. I am living overseas, where health care is uneven, and am not sure if I should seek consultation.
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

I am 33, M, 160 lb with no family history of any heart disease. I wanted to run something by you. A year ago I had an episode of tachy heart was at 140-160 for about 15 minutes. I had a full cadio workup (stress, echo, event monitor, carotid scan) that all came out normal besides rare PAC's at peak exercise and PAC's day to day. For the past 6 months I have been waking up in the middle of the night and upon standing, about 20-30 seconds post standing my heart rate will jump to 120-135 and my heartbeat will be forceful, then it will seem to try to slow down, and then speed up again. This cycle repeats itself for about a minute or two. I feel anxious when this happens. I do not get this when I get up to work in the morning, or after taking a nap, it only seems to happen between 11-3 am. Is this something a test could miss, or should I be concerned. On the event all they said they found was normal sinus tachy, and nothing else alarming, but these episodes feel odd.
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

I am female 67 years old. Ihave undergone 10 years ago a mitral valve replacement with a prosthetic one toghether with aMAZE cryo procedure to protect me from atrial fibrilation.The maze was unsuccessful,atrial.fib come back to me mostly as atrial flluter.I WAS VERY SYMPTOMATIC doctors changed all the timp for other antyarhythmic drug.on the last time i took dronedarone until it stoped working.Now i'm on CONCOR10mg twice a day DILTIAZEM 60mg 3times dayly valsartan 80ng Lipitor20 etct...NO rate control,most of the time the puls is irregular.Iam skeard that the combination of betablocker and calcium chanell blocker could made worser the heart problems(maybe to brink to CHF) I already had implanted a double chamber pacemaker(for what?).Dr Lakkureddy could you give me an advice maybe?
2012-09-28 Answered By : Dr. Dhanunjaya Lakkireddy, MD, FACC, FHRS.

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.

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