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Doctors' Answers to "Frequently Asked Questions" - Heart Problems


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Heart Palpitations [posted 1/13/99]
Question: I currently take 0.15 mg of synthroid and 20 mg of Paxil. I had been having heart palpitations and depression, so the doctor prescribed paxil. I still occasionally have palpitations when my heart beats so fast I feel like I will pass out and my throat feels tight. It happens at any time with no warning. I don't think they are panic attacks. I also feel nauseous and dizzy sometimes. I feel like maybe I am not getting enough sleep, but I sleep at least 8 hours and sometimes nap during the day. Should this be happening while I am on these medications? What else could be wrong? I have a 4 year old girl and an 18 month old boy who keep me busy. Could they be contributing to the problem?

Answer: Differentiating between panic attacks and different heart rhythms is sometimes tough. Occasionally, a holter monitor or event monitor will help in this circumstance. When you experience rapid heart beats, it will cause anxiety. Then you get into a chicken/egg scenario. If the Paxil isn't working, I would try to get your rhythm recorded and see if it is the cause rather than the effect. The sleep problem is probably the Paxil.

Palpitations [posted 1/8/99]
Question: My problem started with palpitation, which made me not want to move for 2 to 3 hours. My vital signs were taken and indicated normal (they were recorded after 3 hours of my palpitation). I have had this palpitation on 3 other occasions, but each time I was in a position to be able to lie down and after a short rest I was ok. This time however I lied down after 2 to 3 hours and when I got up I was drained, but better. The next day I started having this dizziness, tingling in my left foot, chills and nausea that never left and now I live with dizziness (all the time) and nausea (sometimes). I have done numerous blood tests, x-rays, MRI (brain), Holter monitor, ECG and in general they all show normal. I have gone to an eye-ear-throat specialist, Lung specialist, Cardiologist and again, in general, they all seem to think I am not suffering from anything major, but the fact remains that I am still dizzy all the time. I recently started to take meclizine, which helped a bit and when I ran out for one day again my dizziness/tingling, chills, and nausea came back in a big way. It has been 7 months since my first experience with this and it is ruining my life. My doctor seems to think that this is a viral infection in my inner ears and has ruled out everything else. Do viral infections last that long and would they cause tingling on you body? Could my problems be caused by something else? I will see another Eye-Ear-Throat specialist and a Neurologist this month to see what they can tell me. Please help me with any information that might resolve my problem so that I can live a normal life again.

Answer: Well, we usually ascribe things we don't know/can't fix to viruses since they are hard to diagnose and can rarely be treated. However, chronic vertigo can be very debilitating. I know since I had it for 4-5 years in my 20s. About the only thing you can do is symptom control. I have had one or two patients report relief with acupuncture and it's worth a try since we have so few options.

Cardiomyopathy [posted 1/8/99]
Question: A patient with a cancerous prostate has a radical prostatectomy, which showed no other metastasis to any other area. This patent has severe cardiomyopathy, congestive heart failure, and a history of ventricular arrhythmias, chronic angina, with an ejection fraction of less than 20%. Blood loss around 1400 ml. The next day, the patient c/o numbness in left leg, cool to the touch. Patient takes 5 nitro without relief, states he always has pain. He goes for a second surgery the next day to attempt thrombectomy of graft. The thrombectomy was unsuccessful with no retrival of clot. (The patient had in the past a femoral bypass and it was thought that there was either a partial trans-section or ligation of the fem/fem graft). After surgery the patient developed cardiac hypotension and then proceeded into cardiac arrest and died. Was this patient a candidate for this surgery (patient was 79)? Due to age and hx. should an alternative been used?

Answer: Most physicians would have used different treatments rather than surgery on this gentleman if his medical condition is as advertised. Monthly injections of drugs to block testosterone effects or radiation would be the two usual approaches.

Heart rate [posted 1/8/99]
Question: Seven years ago I had a mild heart attack. One year ago I had a six bypass heart surgery. I am taking Captopril, lanoxin, Cordarone, Lasix, Coumadin, and Zocor. I recently went on a diet that took my cholesterol from 352 down to 168 and my triglycerides from 525 to 134. Now my heart rate is getting slower. It has been around 48. Am I taking too much medicine now that my cholesterol has gone way down or could there be other reasons? I also have atrial fibrillation.

Answer: Could be the lanoxin or cordarone doing this. Check with your doctor, most would reduce your dosage. If this is not possible, a pacer may be in the offing.

Heart Problems  [posted 12/04/98]
Question: Over the past year I have had infrequent episodes of dizziness. When it happens, I get a lump in my throat, and feel like I am going to pass out. This only lasts for 15 to 20 seconds, and repeats over a period of three to four hours about four or five times.When I had my last checkup I mentioned it to my doctor. He had me take a heart scan, ekg, stress test and heart echo. The scan and echo showed nothing bad, but when I was on the treadmill, he said it showed atrial fibrillation. He put me in the hospital and started lanoxin and procan sr, along with a heart monitor for two days. The heart beat was steady, but slow, and I have had no symptoms. He prescribed lanoxin once per day, and 2000mg of proconaid twice a day. I feel like I am over medicated. Should I take that much medicine? I should also tell you I take .15 mg of synthroid daily, but a blood test in the hospital showed that my thyroid was normal with this medication. I saw another doctor before I took all of those tests, and he said he thought it was caused by my stomach and put me on percolec (sp)one per day., to control stomach acid. Where am I in this whole mess?

Answer: Procaineamide is not a drug most physicians use for atrial fibrillation. Digoxin, beta blockers and then cardarone is the usual sequence. See a cardiologist. I suspect you are procaine toxic without any clear benefit.

Two Conflicting Opinions [posted 12/1/98]
Question: Since 1995 I have had two cardiac arrests, angioplasty, stent and finally a double bypass. Six months after the bypass I was visiting my son in another city and had symptoms very similar to those I had at the initial onset of my disease. I went to the hospital there and the cardiologist told me I had a "really bad heart". When I returned home to my own dr., he assured me I was good for another 10 years. I just want to try to understand why two highly trained professionals in the same field can come up with two very different conclusions after viewing the results of the same tests which I had while I was in the hospital. It seems to affect my outlook on the future. I have always been very independent, and I don't like just sitting around! Thank you.

Answer: The outlook for your heart varies with the current amount of damage to your heart and the level of stenosis of the arteries. We measure strength of the heart by ejection fraction. A normal one is 55-60% and it declines with age;but, the higher the better. Anything over 30% is necessary for a bypass(which you have had) and in reality, you need a pretty good heart to get off the bypass machine. Ask your doctor what your ejection fraction is, an important number to know.

Treatments for Enlarged Heart [posted 11/4/98]
Question: Can drugs actually reduce the size of an enlarged heart?

Answer: Several drugs can reduce left ventricular hypertrophy. The beta blockers and ACE inhibitors are usually two of the best.

Atenolol, Weight Gain, & Fatigue [posted 11/3/98]
Question: I was born with a murmur and a hole in my heart, the hole is almost gone, but I still have a murmur. I was also diagnosed with Mitro Valve Prolapse approximately one year ago and my doctor prescribed Atenolol for me, I take 75mgs each night. My concern is the weight that I have gained since I have been on this medicine. I weighed 145lbs. for as long as I can remember, and now I weigh 165lbs. I'm 6' tall with a medium build. Does this medicine cause weight gain? I also don't have any energy, something that I had in abundance before. My other question is if I decide to become pregnant, is this safe to take during pregnancy? If not, what do I do? I can't seem to get a straight answer out of anyone here. Thank you  for your time and consideration in answering my questions. It's greatly appreciated.

Answer: Beta blockers usually cause major league fatigue. The Atenolol is a beta blocker. The only reason to take it is to decrease symptoms, it will have little effect on the long term course of your heart/mvp. If you aren't having major tachyarrthymias, I would decrease and stop it. Sometimes the fatigue that the drug induces will cause weight gain, it does not cause it directly. It is entirely safe during pregnancy. Also, avoid caffeine, chocolate etc at these can make the heart more irregular.

Mitral Valve & Zestril [posted 10/28/98]
Question: I have been diagnosed with svt, mitral valve regurgitation with moderate leakage and mild leakage of the aortic valve. I have been taking calan Sr 180mg 1 per day,coumadin 5mg,alprazolam.5mg as needed (no more than 2 a Day) and prozac which is being changed to wellbutrin at my request as I am trying to quit smoking. My cardiologist has added zestril to try to Make the flow of blood through the heart chambers easier, even though my Blood pressure is on the low side. My last reading was 112/64. I am suppose to start the zestril within a week, starting with 5 mg. For two weeks then increase to 10 mg. If my blood pressure systolic reading is 90 or better. Is there another drug i could take to maintain my heart rhythm without lowering blood pressure?

Answer: Zestril is not to control your rhythm, rather it is a drug belonging to a class called ace inhibitors. This class of drugs decreases conversion of renin to angiotension and dilates arteries thus reducing the cross sectional area that the heart has to pump against. While used as a blood pressure pill, its most dramatic results are to improve patients with decreased cardiac output. Often it will actually increase blood pressure if your ejection fraction(a measure of heart strength-something it is useful to know) is low. There is a similar class of angiotension receptor blockers(cozaar, diovan and the like) which probably have similar effects. Ace inhibitors have been better tested at this point.

Heart Problems [posted 10/28/98]
Question: I am a 54 yr old male, family history of heart attack with hight triglicerides (450-750), cholesterol (250), very low HDL's and very high LDL's. Detected at age 29, diet very little help. Doctor started me on 10mg of Lipitor 9/97. Within weeks I was suffering with significant gastro-intestinal agrevation (I also have a problem with irritable bowel syndrome, but this was significantly worse doubling me over in pain), also started significant joint pain particularly hands and knees, also was very tired particularly in the afternoon, all of which doctor explained wasn't likely to be related. Within in 8 weeks Trig did drop to 250, Chol to 135, HDL and LDL's were very close to each other, around 40, and liver function, though elevated was within range. IBS and Joint pain subsided after several months of treatment. The latest blood tests, 8/1998 showed moderate reversal of the the positive improvements and the doctor decided to raise the dosage to 20mg. Within three days, IBS and joint pain returned with a vengence and I am falling asleep at my desk in the afternoon, esp after lunch (very unusal for me). Is it usual to have to raise dosage over time to continue the effect? Are the GI, Joint Pain and tireness among the reported side effects?

Answer: First, with your LDL so low why did he increase the dosage? Secondly, there are other medications (Zocor for example) who tend to have different symptoms. I'd either go back to 10 mg which looks fine or switch to Zocor, this is too aggressive considering your side effectgs.

Complications of Amiocardone Therapy [posted 10/28/98]
Question:What is the incidence of ARDS as a complication of Amiodarone therapy? I am treating a patient that had a primary diagnosis of CHF and now has ARDS of unknown etiology. I am looking for some statistics about how common this is. Thank you

Answer: Pretty small, pulmonary problems over time yes !% or so. Might check with the company's medical division, Wyeth-Ayerst 800-934-5556.

Heart &/or Neurologic Problems [posted 10/21/98]
Question:My mother is 87 and has suffered a massive heart attack over a year ago. However, PRIOR to the heart attack (and persisting), she has these unusual, unchanging set of symptoms. None of the doctor's she has seen are able to figure out the problem.
Her symptoms are:
a. dizziness
b. a tingling or prickling sensation starting in her lower legs crawling upward....much like a limb that has fallen asleep and is awakening
c. when the sensation travels to her head, she feels far away from everything. When spoken to, she feels they are speaking from a great distance. This tingling or prickling sensation moves or crawls around her head. She is greatly fatigued.

Five years prior to her heart attack, she had these symptoms. But they were infrequent and not as strong. Now, they are chronic and greater in strength. She has a stent in one artery. The other is 65%+ blocked. The doctors have ruled out anxiety as an underlying cause for these symptoms. Thyroid = N. CAT SCAN = N. BP = N. If you have heard of this syndrome, I would greatly appreciate this information.

Thank you for providing this service within your site. Sites like yours allow me an opportunity to pool information from varioius medical sources, thereby affording a chance that a solution may be derived at more easily than by her physcian.

Answer: First, do these symptoms have any correlation with her heart rhythm? They certainly could be either too fast or too slow heart beats. Second, get an EEG to ensure that they aren't an uncommon presentation of a seizure. Most of these type symptoms would either be related to her cardiovascular system or neurologic. Get a neuro consult if you can't find a cardiac reason.

Info on Covara for Heart Problems [posted 10/21/98]
Question:I am looking for any information I can find regarding the Seale cardiac agent Covara HS. Particular interest are the contraindications and side effects.

Answer: Covera HS is a time release form of verapamil which is a calcium channel inhibitor. The drug is designed to release a peak at about 4 am (a peak time for coronaries) and then give steady levels through the day. Side effects include slowing of the pulse, constipation and swollen feet. It should be used with care with any other drugs which should be slowing the pulse(beta blockers for example) and can depress cardiac contractility(a problem with heart failure). Other than that usually well tolerated.

Vaso Cardio Syncope [posted 10/21/98]
Question: My daughter was just diagnosed with Vaso Cardio Syncope. Can you please give me any information on what causes this? She has fainted a few times so they performed at tilt table test and gave us this diagnosis. Does diet play any part?

Answer: The vagal nerve goes to the heart and is responsible for slowing the heart rate. This is the mechanism for people fainting at the sight of blood, pain, etc. Without further information, I can't help a lot. But, her heart rate is probably slow or her blood pressure does not rise correctly as she stands. Support stockings, standing slowly and a drug called florinef to expand her blood volume are the usual treatments -but, I need more information to help.

Possible Atrial Fibrillation [posted 10/13/98]
Question: After researching your sight, I now think I have atrial fibrillation. Here's my symptoms. When I have these attacks, it always starts with a strange feeling near my thyroid then my heart just goes wild.. beating so fast and churning in my chest. So hard you can see my whole chest vibrating. Never any pain but it's sure scarey. Finally after a few minutes my heart will seem to stop for about 3 seconds and then go back to normal. This is different from the fast pulse when you get scared. It happens when I'm totally relaxed-- even once while I was asleep. I do have overactive thyroid and take Synthroid every day. My question is, does this sound like what I have, and is it dangerous or just something "scarey" I have to live with. Thanks so much.

Answer: Well, you need to wear a Holter monitor and decide if these are atrial fibrillation or Paroxysmal Atrial Tachycardia. Sounds like PAT. Both need treatment, but the treatment is lots different. Recurrent atrial fibrillation usually requires anticoagulation to decrease the risk of stroke as the heart changes rhythms. PAT can usually be treated with beta blockers;but, occasionally requires radioablation of aberrant conduction tracts in your heart. Contact your doctor to determine what rhythm is present during your spells.

Aortic Aneurysm[posted 10/9/98]
Question: My Dad at 86 was recently admitted to a hospital in So. Florida with septicemia and they discovered an aortic aneurysm. My question: is there any drug that can be used for the aneurysm condition and if my dad were younger is there any surgery for that condition that is highly successful?

Answer: Beta blockers are usually used if surgery is not an option. Surgery is usually the only option and is routinely done on patients over 80 if they have no other contraindications if the aneurism is 5 cm or larger or growing.

Medication Post-Pacemaker Installation[posted 10/2/98]
Question: My father recently had a pacemaker put in. His heart doctor has him on Zestral and Imdur. He is suppose to take 60mg of the imdur. However, the imdur makes him dizzy and sick to the stomach. He has been cutting the pill in half and feels OK. He went to the VA, to get the prescriptions at a lesser cost. They gave him lisinopril to substitute the zestral and isosorbide diniprate to substitute for the imdur. Today, 980817, he had an appointment with his heart doctor. His doctor got about half mad that he went to the VA for the lesser cost medication. The doctor took him off zestral but gave him another prescription for the imdur. From what information I can find the lisinopril is the generic for zestral. I can't find any information on imdur. I can find information on isosorbide dinitrate but not on isosorbide diniprate. My father may have spelled it wrong to me. However, what I did find says the isosorbide dinitrate should be taken with hydralazine. But, there are "considerable side effects". Unfortunately he doesn't have a choice for a second opinion since he lives in a small town with only one cardiology firm for miles around. What do these medications do? Is the dosage too strong? Do they counteract each other? Please help me give him so answers and give us both piece of mind. Thank you.....

Answer: Lisininopril is the generic and is equivalent to Zestril, also to Prinivil. I'm not certain why the cardiologist would be concerned since they are made by the same firm. Isordil(isosorbide) is a time release version of nitroglycerin. Not the same as Imdur which is once a day and usually needs to be given 2,3, or 4 times a day. However, very similar in effect. The dizziness usually means that his blood pressure is too low to function on this dosage of medications. Check his blood pressure at home and especially check it immediately after he stands. Often a problem with older patients. Isordil can be given with hydralazine;but, often produces major blood pressure drops. Sounds like his cardiologist is being a bit of a prima donna.

Atrial Arrhythmia [posted 8/7/98]
Question: Cardiovascular status required for acceptable reduction of current dosage of sodium warfarin (5+5+2.5 mg in 3 days) to lower dosage of coumadin (e.g., to <2.5 mg) + aspirin. Concomitant medications daily: atenolol="l25" mg, verapamil="180" mg. What would be lowest effective dosage of sodiuer arfarin if aspirin is taken concurrently?

Answer: I need to know the reason you are going this direction, recurrent symptoms is the most common reason. High risk patients are put on combinations of aspirin and coumadin, but usually with therapeutic range coumadin - not lowering the range as you are inquiring.

Heart Medications [posted 8/6/98]
Question: Can betapace and calan cause seizure type episodes? Do they cause mental confusion and total lack of appetite and desire to drink? My 73 year old father recently was put on betapace and had a fainting spell within 45 minutes of taking the drug, had a seizure like episode, regurgitated, ended with pneumonia and a pacemaker. His mind wandered for weeks, and he refused all nourishment and was combative. Within 2 days of withdrawing both drugs, his appetite returned and so did his mind. His doctors call it altered mental status - I wonder if it wasn't chemical poisoning of some degree?

Answer: Both betapace and calan can slow the heart rate. This slow pulse could affect the circulation to the brain and appear to be a seizure - more likely a bradycardic spell with symptomatic hypotension. Sometimes, the drug is still necessary and a pacer is necessary to block the effects of the drug. With the rapid change after stopping the drug, it sounds like either the drug or the lowering of his blood pressure were responsible for his altered mentation. I would be very suspicious of drug side effects causing his problem.

Panic Attacks or Atrial Fibrillation [posted 8/4/98]
Question: Now and then, I experience episodes of rapid heart beat accompanied by dizziness, nausea, pressure in the chest, and general discomfort. Occasionally, I also tremble and shake, but not always. I really have no fear that accompanies these attacks, except for fear of the attack itself. I have had several ECG's that have been normal and a 24 hour Holter monitor test read normal also. Yet, I have these occasional "spells" and sometimes my heart flutters. Without factoring in the "fear", should the attacks be diagnosed as panic attacks or paroxysmal atrial fibrillation/flutter?

Answer: When you did the holter did you have a spell? If not then there is no current diagnosis. There is a type of monitor called an Event monitor. This is worn for long periods and turned on when you are having a spell. The only clear way to decide the type of rhythm is to ensure that you have a monitor strip while you are having symptoms. Then one can say whether it is recurrent Afib or whatever.

Heart Palpitations [posted 7/24/98]
Question: I have had problems with heart palpitations for about 15 years and I am 35 years old. I don't have them continuously - the last time I had them was when my Dad passed away in 1993 of a heart attack. I took Corgard for 2 years after that. Now I'm having them again and my doctor prescribed Tenormin. I've had all the tests to check for any abnormalities of the heart and everything is good. What could be causing this off and on like this?

Answer: Hard to know for sure, but if the beta blocker works I wouldn't be especially concerned about it.

Accessory Pathway in Heart [posted 7/23/98]
Question: Can you please tell me about the condition in which a person has an extra electrical circuit in their heart?

Answer: Some patients are born with an extra electrical pathway called an accessory pathway. This may not cause any problems, but in some patients produces very rapid heartbeats called circus rhythms due to the circular nature of the electrical discharge in the heart. Until about ten years ago this was difficult/impossible to treat. However, pioneering work at the University of Michigan and others allowed electrical ablation of the accessory pathway using radio frequency waves directed at the site of the problem. This is very effective and some patients will experience slow conduction afterwards and require a pacemaker, but they are a minority. They tend to run in families and appear to be inherited in some complex way.

Heart Problem, Synthroid and Atenolol [posted 7/21/98]
Question: I'm asking this for a friend, age 50, whose heart has been behaving oddly (pulse dropping on increased exertion) but has no blockage. She has been taking synthroid, 1 per day 100 mcg. What are its side effects? Now added is atenolol, a beta-blocker, 25 mg, 1 per day. What are its effect and side effects? How about in conjunction with the other drug? We would much appreciate knowing of any potentiation or interaction of these drugs that may produce these effects.

Answer: Atenolol is a beta blocker, known to slow pulses and is probably the cause of the problem. The thyroid replacement would not cause the problem if her TSH is normal and I'm sure she gets it checked occasionally.

Atrial Fibrillation, Atenolol, and Sports [posted 7/17/98]
Question: I am a 42 year old triathlete. I began having regular episodes of rapid heart rate, shortness of breath, chest pain, light headedness on a regular basis with exercise. I was evaluated and found to be having problems with atrial fibrillation. As treatment, I was placed on 25mg of atenolol. The drug has helped the afib to stop, but it has created severe limitations in my exercising. Is there a better drug to control the AFIB that won't impinge on my athletic performance? Can surgical procedures eliminate the problem and the need for drugs completely?

Answer: Most of the drugs to control rate may have effects on your athletic performance. But, digoxin and amiodarone are two possibilities. If these fail you might see an electrophysiologist (specialized cardiologist) to see if electrical ablation is an option. This is ablation of the electrical tract by a catheter put into the heart during a catherization procedure which destroys electrical tracts by high frequency radio waves.

PSVT
Question: I am a 32 yr. old male being treated for PSVT. I presently am taking .25mg Digoxin/day and 50mg Tenormin/day. I am still having episodes of PSVT on occasion, usually set off by physical activity. I am hesitant to advise my doctor due to risk of losing my job. What other medications would possibly work in my case? Is PSVT purely a defect that I was born with, or is there another cause? I work in a very stressful job (Air Traffic Control).

Answer: PSVT is usually fairly well controlled with beta blockers. Increasing the dose would be helpful if you can tolerate the side effects(fatigue, low blood pressure, etc.). Also, verapamin(a calcium channel blocker) can be helpful. In certain circumstances an electrical physiologist should be contacted to see if this is really PSVT or another rhythm. These can sometimes be corrected using a catheter to ablate certain areas of the electrical conduction system of the heart.

Heart - "P-Waves"
Question: My physician told me that my recent EKG indicated random "P-Waves" (sounded like). What are "P-Waves"? Are they serious? I am a hiker and runner.

Answer: P waves are the waves on the EKG that correspond to the atrial contraction. These are followed by the QRS complex that represents the contraction of the ventricles. The atria(Latin for door) are the top two chambers of the heart. They act as priming pumps or turbo chargers for the ventricles; that is, they pump just before the ventricle to inject extra blood into the ventricle and allow it to pump more blood. This adds power to the heart much like a turbo charger. If you listen to your heart it will usually have a classic lub-dub sound. The lub is the atria pumping blood into the ventricle. I'm not sure what he means by random P waves. I doubt it means anything of consequence. I suspect he means that there is an occasional beat that is not perfectly regular. This is common and usually doesn't mean anything, but I'd have to see the EKG to tell you for sure.

Congestive heart failure
Question: My father (age 88) has been diagnosed with congestive heart failure and emphysema (non-smoker). He takes Zestril (5 mg), Lanoxin (0.25 mg), Meclizine (12.5 mg 4 times/day), and Furosemide (40 mg) doses daily plus aspirin. He frequently complains of dizziness. Could his dizziness be reduced or eliminated through readjustment or elimination of his doses or addition of another drug?

Answer: First of all you'll need to determine the cause of the vertigo(dizziness). If it is due to insufficient blood flow to the brain caused by a narrowing of the carotid artery or low blood pressure caused by his heart medications(easily measured ) then decreasing these medications may be of help. However, if it is due to nerve damage, etc... then the medications will not help. Occasionally, digoxin will produce this effect-- so a therapeutic holiday from the drug may be of help(drug levels are also available). Discuss this with the physician and try to come up with a plan to eliminate one drug at a time-- after he has had a proper evaluation. I'd start with digoxin first. If eliminating the drugs doesn't help, then there is little you can do to change the situation.

Atrial Fibrillation
Question: I am a 60 year old male and have been diagnosed with AF since I was 30 years old. I have been having a recent bout with both irregular and fast (114/min.) beats. My doctor has tried at least 4 different forms of Beta Blockers, none of which seem to help. I was on Verapamil (180 mil) and Sectral (200 mil) for a number of years, and it seemed to be sufficient. However, I began to revert to the old arrhythmia and went to a Cardiologist. He has tried Corgard, Tiazac, and Rythmol. None have been effective. Now he wants to try Atenolol. Is it really this hard to control AF? It's been weeks since I felt good or have been able to resume any of my normal exercise or work routines.

Answer: No, it’s usually not that hard to control. Beta-blockers, digoxin, and calcium channel blockers are all used for rate control. Occasionally, amiodarone is used to maintain sinus rhythm if this can be restored-- usually not for rate control. Atenolol is a beta-blocker and should not have any better effect than any other. Combinations of beta-blockers, verapamil, or equivalent channel blockers and digoxin are sometimes necessary. If these do not work you may need a catherization to check your electrical system(called electrophysiology).

Heart Problems
Question: My neighbor has experienced cardiac problems: defibrillated twice, "coded" and revived, dangerously slow heart rate. The hospital which treated him sent his records to the Dept. of Transportation. He is active duty military. Military doctors treated him with beta blockers, tried a pacemaker then removed it, and the final diagnosis is vasodepressor syncope. They say there is nothing to do for him and make light of his symptoms. Meanwhile, the DOT revoked his license for life. Subsequently, the military is forcing retirement; yet; they say he is not disabled. This seems excessive on the DOTs part, to be an invasion of privacy on the hospital's part, and like a lot of passing the buck to me. What sort of medical tests should be done on this 36 year old relatively fit Purple Heart recipient?

Answer: Having been in the military for five years, I can sympathize with this gent. I'd suggest a workup with a competent cardiologist. This should be no more than $600 or so if copies of the military tests are obtained. However, if he needs electrophysiology or something exotic he can be referred back to the military-there are competent physicians in the military the trick is getting to them. Get his congressional representatives involved.

Right Bundle Branch Block
Question: My life insurance company re-rated my policy after they did an EKG. They found a complete right bundle branch block. I then had a thallium stress test that ruled out any CAD and was told that my heart looked great. The doctor said RBBB is very common and does not cause an increased health risk factor for me. The cardiologist also confirmed this and said my insurance rate should not be changed. Do you concur with them? Also is there a cause for a RBBB?

Answer: Right bundle branch block is a relatively common conduction abnormality of the heart. Abnormality refers to the frequency and cause of the condition--not necessarily that it is pathological. That is, most people with RBBB have absolutely no cardiac problem. Insurance companies by nature are risk avoiders. Since they have difficulty defining the risk of RBBB they will increase your premium. That does not mean that you have anything wrong with your heart or are at increased risk. It means that the company cannot predict your risk to them.

Heart Quivering / Palpitations
Question: I am 50 year old female, past menopause and on hormones. Presently I am seeing a cardiologist for a prolapsed mitro valve and an irratic heart beat tachcardia (3 times daily). I am on 50 mg daily Atenol. I also have Grave’s disease and am on 0.112 mg daily of synthroid (radiation was used on my thyroid). The Atenol controls my blood pressure and helps with many of my symptoms, but not all of them. My symptoms have worsened considerably this past year and include some periodic chest pain, rapid heart beat, almost constant fluttering of my heart beat, occasional dizziness, loss of partial vision for 20 min. in one eye twice this year, and night sweats that are accompanied with vibrating in my chest and neck area that feels like my heart is humming like a motor. This does not seem to have anything to do with emotion, exertion, etc., and occurs slightly during the day, but happens whenever I turn over or move in the night. If I wake up in the morning I have to literally wait about 2 minutes for this to cease. If I am ever startled, the "motor" goes wild and makes me dizzy. I have noticed that if I physically exert myself a great deal during the day that the nights are especially bad, waking me up with the "humming". I felt at one time that this was due to adrenaline rush maybe due to the Grave’s disease, but I am coming to believe that my heart quivers. My cardiologist does not give me any reasons. I have an appointment next week and will insist on having tests done. No tests have been done on me in over five years with the exception of an EKG which came back "slightly abnormal" 14 months ago. The doctor says that I have type A personality and to slow down, but does not let me know if this is truly serious. The "quivering" is almost unbearable and I need to find out what is going on. Do you recommend a specialist? Should I change doctors? Other symptoms include a low pulse of 42-48, blood pressure normal on medication 110-70, with an otherwise occasional jump to 170-180 over 120/125 with an extreme headache with a lot of quivering. Also, there is quite a history of artery disease in my family.

Answer: The first question is what is your heart rate with the symptoms? If fast, these need to be controlled. If not fast, these may be panic attacks. A holter monitor or event monitor will help to find out. Also, patients prone to Grave’s occasionally have other associated endocrine problems. An increased rate of Diabetes, Myasthenia Gravis, or Adrenal problems, etc. Have these been checked? Start with the holter to see your heart rate during the spells. It sounds too slow from here.

Heart - Ventricular Tachycardia
Question: I'm a 23 year old male and I was diagnosed with ventricular tachycardia. The doctors that I am seeing are recommending that I stay on a beta blocker for the rest of my life. I was wondering if you think this is safe? I was also wondering if there are any other options other than drugs that might cure this. I’ve had an MRI that looked normal, a heart cath that showed nothing, and an echocardiogram that looked good. The only time this occurred and the doctors have recorded was during a thallium stress test. I also had an episode of supra-ventricular tachycardia. If you have any information or can help me in any way it would be very much appreciated.

Answer: Beta Blockers are common drugs used to treat many different problems. They are very effective in treating hypertension, angina, rapid heart beats, stage fright and occasionally anxiety. They also have similar side effects. Beta Blockers come as selective and non-selective. The non-selective beta blockers can cause some bronchospasm and asthma. The selective blockers can also, but much less frequently. Common side effects to both selective and non-selective beta blockers are fatigue, slow heart rate, nausea, nightmares and difficulty sleeping, impairment of insulin release, depression, an occasional skin rash. These drugs should never be stopped abruptly and require a tapering if discontinued. There do not appear to be long term side effects and patients are often on these drugs 20-30 years. An alternative would to be referred to a cardiologist who is a specialist in Electro-Physiology. Occasionally radio wave ablation of different parts of the conduction system of the heart will "cure" the problem. This will need to be evaluated with a special catherization and can only be done by specialized cardiologists. They are available in most major cities.

Heart Flutters
Question: I have had heart flutters from time to time, especially after consuming coffee. I am in my twenties, and also have hypoglycemia. I do not drink a lot of coffee (three cups a week). I have also noticed that during high stress times, the flutters happen more often. What role does caffeine and stress play in the fluttering of my heart?

Answer: Caffeine belongs to the class of drugs called methylxanthines. This includes theobromide, caffeine and theophylline. These are a class of drugs that produces cardiac irritability in some people. Some people are exquisitely sensitive. If the drugs do cause irritability, I'd avoid taking caffeine in any form. Also, avoid chocolate and tea. Be aware that decaffeinated does not mean caffeine free. Also, certain over the counter medications (Excedrin, etc. ) contain caffeine.

Heart disease
Question: I'm concerned with what seems to feel like my heart stopping for an instant. I've experienced this and have usually passed it off for palpitations. I am a 40 year old female, 145 lbs., physically active, subject to anxiety, somewhat hyper, and I drink up to four cups of coffee a day. I had a complete physical in March and my doctor said I should live to be 100. However, he never really tested my heart. I've read that heart disease can go undetected, especially in women. My father had high blood pressure and ended having a major stroke. My older sister (now 48) had open heart surgery when she was seven to close a valve that was a birth defect. I have a brother, who also had open heart surgery at age 18 when a company doctor detected a murmur during a routine exam. He also had a valve defect. I am concerned with this reoccurring sense of my heart skipping a beat. It seems to only occur when I am sitting. Should I be concerned? What could cause this? It is not painful, but if it lasted for a longer period of time I could definitely associate it with extreme pain.

Answer: These isolated palpitations are usually of no importance. Approximately 40-50% of the population will have an isolated extra beat every 4-5 minutes. Actually, the ones you feel aren't the problem. It is the preceding beat that is early which gives extra time to fill and a "big" beat is what you are feeling. Caffeine, alcohol, lack of sleep and stress can produce these and I'd cut out the coffee for awhile and see if they vanish. If they were any problem you would experience them with exercise and not at rest. Your brother's history is of little relationship to your problem. Women in their 40s and early 50s occasionally have these with estrogen withdrawal also.

Heart Disease
Question: My father-in-law was operated on in early November 1996 for a double bypass and the replacement of a heart valve with a pig valve. His post-operative complications included uncontrolled blood loss, critically low blood pressure, poor healing, etc. These post-operative conditions necessitated his stay in a critical care unit for nine weeks, intensive care for two weeks, etc. resulting in a 2 and 1/2 month hospitalization. He is now home, but only able to walk with assistance, and he is on a heavy dose of diuretics. We are now hearing about the potential for congestive heart failure. Can you explain what this is; causes, symptoms, how to preclude this condition, etc.?

Answer: I’m sorry not to be able to help, but this is too complicated without further information. I’d discuss it with his physician. It would be helpful to know the injection fraction before and after the surgery. This is a measure of heart strength and it sounds like his is lower than before surgery.

Cardiology
Question: I had a heart attack in December 1996 and was given Lopressor. I experienced breathing difficulties and was given Imdur. Breathing became even more difficult and this raised my blood pressure to dangerous highs of 190/132. After subsequent hospitalization I have been taken off Imdur and Lopressor and been put on Norvasc. I also have asthma induced from industrial accident in 1981. How more effective are the Beta Blockers compared to Calcium Channel Blockers?

Answer: Studies are currently ongoing to answer this question. Clearly, beta blockers are more effective at preventing heart attacks. However, calcium channel blockers are no slouch. Most patients have difficulty taking beta blockers and the side effects block them from taking the medication. So, even though they are probably 20-30% more effective, many people over the age of 55 cannot tolerate the side effects. We should have better answers in about 1-2 years.

Heart condition
Question: I have had heart disease for a long time. I had open heart surgery for mitral stenosis. The valve was not replaced. I developed a sick sinus and had a dual chamber pacemaker implanted. I'm unfortunately very anxious. I'm treated with xanax.

I recently began having episodes of tachycardia (120 beats). Doctors are not concerned. I would just like to know about the sensation which seems to be a slowing of the heart then back to the faster beat. It reminds me of the bride I used to have, but the doctor says it can't be. I'm almost 65 years old.

Answer: Usually the beats you feel are not f any great concern. The ones that could kill you will not be perceived until you are passed out. What you are probably feeling is a sinus pause. This occurs when your heart slows a bit and either the pacer kicks in or your own intrinsic cardiac pacer. Because there is a slight pause between beats, the heart has extra time to fill, creating and extra large beat. This gives a feeling of a pause and then a “thud” or large beat. Actually, this is normal and has no significance, but it feels like your heart is stopping.

Chronic Rheumatic Heart Disease
Question: I am a patient with CRHD with MS & AR. Besides, I had pneumonia previously and I am currently always having a sore throat. I consulted a doctor and am now on phenoxymethylpenicillin 500 mg twice a day for 2 weeks. I would like to know about more the CRHD and other information which you consider is relevant for me.

Answer: Rheumatic heart disease initially results from infections due to Strep species of bacteria. Not everyone who develops strep throat will get rheumatic valvular disease. There appears to be genetic predisposition to rheumatic valvular disease. Consequently, if one develops valvular disease with one strep infection-the probability of recurrent inflammation and damage is high. So, we treat all sore throats in patients with Rheumatic Fever, Scarlet Fever, etc. with penicillin or an equivalent.

Heart Problems
Question: I have a 23 year old friend, who was diagnosed with Hypertrophic Cardiomyopathy. Her father has the same diagnosis and already experienced two hear-attacks. He is taking medication for his condition. But my friend was diagnosed with the same condition and was told only to rest and avoid any exercise or not even to carry her heavy school bag. She is suppose to come back for a check-up in a year, which will be July of this year. I looked in books as far as treatment, but they only talk about prescribing some medication (beta-blockers). Is this condition reversible or curable? What other actions can be taken to help reduce the risk of a heart failure? This illness was diagnosed in former Eastern Europe, and they are seeking information how this is dealt with over here.

Answer: Hypertrophic cardiomyopathy (HCM) is a disorder of the heart muscle (“myocardium”), that is the result of marked thickening (“hypertrophy”) of the muscle fibers, and results in poor heart function. Its causes are several. In the elderly, long standing ">

Your friend is 23 years old, and it is therefore more likely that she has a particular kind of HCM known as idiopathic hypertrophic subaortic stenosis, or IHSS, which results in a hypertrophic cardiomyopathy due to abnormalities in both the electrical conduction system, as well as pump function and motion of the heart muscle itself. This disorder is felt to be genetic in etiology, but the exact way in which the disease is inherited in as yet uncertain.

Patient with IHSS can experience symptoms that are due to either electrical problems or “pump” problems of the heart, and include blackouts/fainting spells, dizziness, chest pain, shortness of breath, especially with activity, and palpitations. Of even greater concern, are the possible complications of this disorder, which include heart injury (myocardial infarction, or “heat attack”), heart failure, stroke, and cardiac electrical conduction or rhythm problems, and resultant loss of heart beat. These patients can experience what is known as “sudden death” due to cardiac rhythm problems, which can be worsened or occur with greater likelihood when the heart is stimulated, as it is during exercise, for example. There are therapies available for IHSS, including medications (Beta blockers, anti-arrhythmic drugs, and calcium channel blockers), as well as surgical procedures for those who do not respond to medicines. There are also newer therapies, including permanent cardiac pacers, and more recently, permanently placed cardiac defibrillators, which are devices that “reset” the heart rhythm if a fatal rhythm disturbance is detected. Your friend may benefit from discussing with her physician all the therapeutic options available to patients with IHSS. Close follow up is essential to assess response to a given therapy, and to determine what additional therapies can be pursued.

Treadmill Test
Question: I have a friend who has heart problems and was also on Phen-fen for 3 months. They are considering doing a Cardiolite treadmill test and I am wondering how dangerous this test is since I have heard it could be fatal. Why would they do this test which seems to be quite dangerous when they could do an angiogram instead. I'd appreciate an answer soon, as they may want her to have this test next week. She is 49 yrs. old and has chest pain and SOB.

Answer: A treadmill test will give no information concerning cardiotoxicity of fen-fen or equivalent. An echocardiogram is the best test. Angiograms are much higher risk.

Different Diseases
Question: What are some Diseases of the heart.

Answer: Several types-more detail would need a textbook. They are congenital, infectious, trauma, malignancies, vascular , inflammatory, atherosclerosis, hypertensive and a large class called other. Each sub-group will have many "diseases" listed along with the cause and treatment.

Heart Failure & Angina
Question: I am suffering from heart failure and angina. My angina usually starts with pain at the right side of my head,which then radiate to my jaw and my chest. Sometimes I would just have pain at the right side of my head which would stop as soon as I used my nitroglycerin spray. I would like to know if it is normal to have pain on the right side of the head just before an angina attack. I have read many articles about angina and none has listed headache as a symptom of angina. I would like to know if my headache could be as a result of a narrow artery in my neck or my head,since my headache is only at one side of my head. I am a sixty two year old female.

Answer: Very unusual for right sided pain. In reference to your previous question has your gall bladder been evaluated? This would cause vomiting as well as right sided pain-often relieved by nitro.


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