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September 26th, 2016
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Hello Doc. I am now 26 years old.I was diagnosed with ASD at the age of 26 and went for ASD closure 1 month before. I was an athlete and loved to do vigorous activities. But after the operation, I couldn't really do the activities like i used to do. Even if I could them, I will be having some pain and discomforts at my chest . My doctor said that my heart was quite strong. But when I am stressed or tired, I felt like something is wrong with my heart. There was a time when I stayed up all night to finish my work and when I lie down to sleep, I have to make an effort to breath. Why do I experience such things? And is it risky in the future?
2013-06-20 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

Thanks. If you are having difficulty breathing when you try to lie down, then you should go to the ER. If things are not that severe, they you should still contact your doctor straight away to discuss this. There are many possibilities, and only your care giver who knows your full history can go through these possibilities with for.

Hi. My father is 94 years old had a blackout whilst standing and fell beginning of June 2012. He now has a hangman s fracture and now showing very visible signs of congenital heart failure . His legs are leaking badly. He also has good days when he is ultra alert and other times spaced out. How long can this go on for? He signed his own advanced health directive with his doctor a few years ago. He does not want to be kept artificially alive. How long can he go on for in this condition? please suggest
2013-06-20 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

Thanks for your question. However, this is a very, very difficult one. In general, it is very difficult to "predict" how long any particular condition can go on for. Instead, it would be more useful for you and your father to have a long discussion with his doctor(s) to address all of these concerns. It is possible that altered medications for his heart failure may improve his health.

Hello Doctor. I went to the ER last week with a racing heart doctor said my EKG was fine. My friend told me I may be in atrial fibrillation. My heart did feel funny but was in a regular rhythm. My blood work came back elevated which they said was for heart failure but my cardio was not concerned because the CT, chest x-ray, EKG and echo was normal. What could be my problem? Please explain??
2013-06-20 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

It is quite common to get a "racing heart beat", and often this is a normal rhythm - sinus tachycardia - and not atrial fibrillation or another arrhythmia. It would be nice to know what the ECG showed when you had your symptoms in the ER. If this is not clear, then if the symptoms are recurrent a "wearable ECG" (event monitor or Holter) would be useful. Your doctor can then decide what course of action (if any) to take. Thanks.

I am female, 56 and in very good health. I have never been overweight and do not have diabetes. I do not smoke or drink alcohol.I developed an arrhythmia while in post op for a hysterectomy (Nov 2012). I had never experienced episodes prior to this. I wore a monitor in the hospital for two days, with no events. I had a break through event two weeks post surgery and was placed on Flecainide, as I did not tolerate Metropolol (have low blood pressure). Flecainide has not been effective in controlling symptoms. I have episodes 1-2 times per week. I can feel them, but they do not stop me from daily activities or exercise. No trigger has been determined. Both resting and stress ECHOs have been normal. My blood pressure remains Low/normal. I have had a few episodes with rapid heart rate, but generally my heart rate is below 100 during episodes. During episodes, I will have 10-15 normal beats, then what feels like a prolonged beat. I had a second appointment with an EP today. Since November, I have been told I have Atrial Fibrillation. However, I requested copies of my hospital records and the ECG from post op (the only recorded episode) indicates Atrial Flutter with predom 4:1 AV block. The accompanying cardiologist report states \"Course AFib at HR 128. Has some flutter like waves but predominant rhythm is fibrillation.\" I am concerned about this discrepancy. From what I have read, Flutter and Fibrillation are quite different and are treated differently. The EP suggested ablation for flutter and described it as a much simpler procedure than that for fibrillation. My question--with the conflicting reports, shouldn\'t I wear an event monitor or go through some evaluation to determine whether I have flutter or fibrillation prior to recommending treatment? Also, is flecainide appropriate for flutter? I have read it should be accompanied by an AV blocking agent. Thank you for your input.
2013-06-19 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

Thanks for your question. The distinction between atrial flutter and fibrillation is important, as you say, and is something that your cardiologist can probably resolve by looking at all tracings. If there is any doubt, then getting another ECG or Holter monitor (it sounds like you are in the arrhythmia frequently) would be a good idea. Once that is done, then if you cannot tolerate this (or another) medication, you would be a good candidate for ablation. Many practitioners would ablate both AF and \"atrial flutter\" (if that is indeed what it is), but what you actually have needs to be resolved with your doctors first. Thanks.

FWIW: Age: 77. (1936) Currently being treated for permanent Lone Afib RPR 80-85 bpm. Prior RPR had been 55-60 for many years. Only med is Warfarin. Also successfully using CPAP for Apnea. Afib turned permanent about a year ago, following preceding 5 years where brief periods of arrhythmia and apnea remained undetected by doctors. Apnea/Hypopnea were diagnosed, soon after Afib confirmed. Tikosyn trial/ and 2 cardioversions failed at one week duration. Discontinued Tikosyn. Following approx 5 months experienced (new)excessive day time sleepiness, forgetfulness, poor access to normal vocabulary. This has improved as I became accustomed to CPAP use. My current feeling is that (for whatever reason), mental performance is slowly, but steadily improving. (My wife endorses this observation ;-) . While my present situation appears tenable, I would like to consider FIRM ablation at a future date if it appears reasonable, and without high probability of multiple \'repeats\'. Would like to know also, if you currently envision cryo-ablation being combined with the FIRM technique.
2013-06-18 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

Many thanks for this question. First, I fully agree with your decision to persevere with CPAP for sleep apnea, since many studies have shown that this treatment can improve many facets of your health, including stamina and energy levels as well as possibly helping with AF in some patients. Any form of AF ablation could certainly be considered in your case, depending on whether your symptoms are related to AF, and not sleep apnea (or something else). FIRM is certainly an option, and several centers will be able to evaluate your suitability for this. Finally, Yes, some centers have actually combined FIRM with cryoablation for pulmonary vein isolation. I hope that this answers your questions.

I am a 73 year old avid cyclists. I have had 3 cath ablation and a minni maze for Afib and one week ago a cath ablation for Aflutter. Right now I am in nsr with no arrhythmic drugs, I am on xeralto. During the minni maze my LAA was stapled off, but recently it has developed some minor leakage. My question is do I need to be on any blood thinners? It seems to me that the general population\'s LAA is open and mine is only slightly open and I am in stable nsr that I am at no greater risk of stroke than the general population. I worry that if I should fall off my mountain bike that I could sustain some serious internal or intracranial bleeding. Thanks: Jack
2013-06-18 Answered By : Dr. Sanjiv M Narayan, MD, PhD, FHRS

This is an excellent question. Whether to continue or discontinue blood thinners, in this case Xarelto, is based upon more than whether you are in sinus rhythm at the current time. Firstly, you have recently had an ablation and so I would generally recommend to continue Xarelto for at least 8 weeks. Secondly, after that time, the decision is heavily based upon other factors in your past medical history, including prior stroke or \"mini-stroke\", diabetes, or other factors. You should discuss this, and the \"open\" left atrial appendage, with your physician to make the final decision.

Hi, I'm male, 23 and reasonably healthy, for about 5 years now I've been suffering with heart palpations. To be more specific my heart will occasionally skip a beat or do some kind of double beat, for years it really bothered me, i made several trips to the doctors, had two ECG's and a blood test, but nothing was found to be wrong. Over the years I've came to live with it and learnt that generally i think it's caused by anxiety, stress and in some cases food/caffeine. Most of the time i try to not let it bother me, but it's always a niggling concern in the back of my mind and i have been given no explanation by a doctor as to what it could be (even if it is just anxiety, that has not been suggested to me). I'm sure anxiety plays a big part but i don't think i can be the sole cause. Anyway, over the past few days I've felt myself feeling quite under the weather. I've been feeling nauseousness, had hot flushes and random sharp short headaches, today it went a step further and actually got a little scary for me. I began the day feeling quite weak and my heart felt very obvious to me in my chest, i was very aware of its beating, but it wasn't beating particularly fast. It skipped a beat and i didn't think much of it and then it did it a few more times, at one point after a skip i would sometimes feel a sudden rush of blood around my chest, my face became very hot and i became instantly nauseous. I tried to calm myself down and it probably only lasted for about 20 minutes on and off and i spent the rest of the day just trying to be relaxed and calm. What i want to know, if this is something to be worried about? Is my doctor right and it's nothing to be worried about, or is there some underlying condition that I'm perhaps making worse by thinking about it. Are there any other tests i could request to have done to help put my mind at ease? Could anyone provide information?
2013-05-02 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

You should do an event monitor to correlate your symptoms with your heart rhythm. This can be arranged by your doctor or he can refer you to a cardiologist for it.

Hello. I am a 40 year old male Caucasian 172cm, 71kg, and normal blood pressure. I exercise a couple of times per week and don't drink or smoke. I had a heart exam 3 years ago following some unexplained chest pains which included a treadmill stress test. My heart structure showed up as normal in the echo and so I was told that I had nothing more than IRBBB. The Duke Treadmill Score was -29. I have unexplained blackouts twice per year and sometimes feel like I have strange heart rhythms before I go to sleep. Recently I have needed to nap more in the daytime and feel excessively tired. My GP wants me to have a sleep test for sleep apnea. I have also had another of my blackouts. I am concerned that my unexplained blackouts could be caused by Brugada syndrome. I am considering going back to my cardiologist but it is expensive here so I want a second opinion to review my ECG results before I make an appointment.
2013-05-02 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

I agree with doing sleep apnea study for your symptoms. You will need a heart monitor to assess for abnormal rhythm and blackout spells. The duration of monitor depends on the frequency of symptoms ( Holter monitor for daily episodes and event monitor for episodes that are less frequent). This can be arranged by your GP. You need to see your cardiologist for the blackout spells and ECG analysis.

Hello Doctor. My partner had 5 heart bypasses and a hole in his heart repaired 3 weeks ago, he did absolutely fantastic and came home on day 6, completely mobile and well. Now he seems to be getting worse by the day, especially at night. They took an artery from his left arm and he has totally bad tingling in his fingers and very sharp stabbing pains all up his arm from his wrist to the top of his shoulder and down his neck. This is really getting him down as the pain is excruciating and pain killers just don't help. He is having tramadol and paracetamol and just this morning I tried him on 500mg ibuprofen. Have you any ideas and is this usual after surgery? He is used to being very active and was only ill for about 2 months before his surgery....it came on very quickly, and he is only 47 which we are told is quite young for this operation!! His Dad did have surgery at his age but unfortunately died 6 years later, so they have said his heart decease was hereditary rather than lifestyle. Please help
2013-05-02 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

You need to contact the surgeon for the pain.

Im a fit athletic 23 year old male...all natural (no sterioids). I eat well and am the ideal weight. I only go into A-fib occasionally when I choke/vomit, donate blood, or get inebriated (the later happens rarely. It was in early college days when this was discovered). I was diagnosed with hypertention in High School in which me and my family were in denial about. (Why? no family history, Im young and healthy). I saw several doctors at NYU, St. Francis in Roslyn and No. Shore University hosp.) I had a 2 week heart monitor in which the report found nothing except a few normal palpitations and irregular heartbeats. One Dr. said I had a benign condition. Some Drs say it is not worth the risk and some say to go for getting ablated. I really cant be bothered getting cardio-verted in the ER 1 or 2Xs a year. Im am presently on 50mg of tenormin and 75mg of effexor. My BP has been at bay ever since I started these about a year ago. I really dont want to be on these forever meds. Its so early in my life and there will be side effects in my future, no?. My Dr. prescribed these both because he felt I was stressed and under pressure being on a college ball team trying to make it in the majors. Im done now. Can I get weaned off? Will the afib come more often if Im off these meds? One of my past Drs. was reluctant to prescribe a pill in the pocket just in case... he says its too dangerous for me. why?? He gave it to me once but it took several hours before it kicked in for me. I also once went for a vigorous run for a few miles and came out of a-fib. Can I have a heart attack from it? I have also seen endocrinologists to rule out other conditions like pheocromocytoma and cushings disease. All bloods,EKG and Echo normal and checked yearly. What is your opinion? I dont want to have a stroke if I wait a day for it to pass. Please help. Thank you Dr.
2013-04-29 Answered By : Dr. Nitish Badhwar, MD, FACC, FHRS

You have vagal induced lone atrial fibrillation based on triggers as well as response to exercise. The treatment is based on duration and frequency of symptoms. Your stroke risk is very low given young age and one risk factor i.e. hypertension. A beta-blocker like Tenormin is good to use for blood pressure as it helps control the rate during episodes of atrial fibrillation. You can try pill in the pocket (Beta-blocker + flecainide or propafenone or norpace) as it is better than going to the ER...usually take 1-2 hours to convert. I have my patients come to the office or go to ER the first time they do this to ensure they don\'t have fast atrial flutter with the strategy. The decision to do catheter ablation must be based on increase in duration and frequency of episodes as the main goal of the procedure is symptom relief.

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