E-mail received:

Please give me a simple definition of PPS murmur (peripheral pulmonic stenosis) and what it entails. My 3 week old daughter has it. Should I worry? Thank you

Dr Matthews response:

The murmur comes from a narrowing of a segment of the pulmonary artery above the pulmonary valve or the narrowing can be in one of the pulmonary artery branches(right or left).The murmur is a harsh noise peaking in the middle of the cycle of the heart contracting to push blood through the pulmonary artery. The blood going through a narrowed segment of the pulmonary artery creates this noise,best heard just to the left of middle line of the chest, up close to and under the left collar bone(clavicle) and can also be heardunder the left arm and in the back! The clinical course is favorable in most patients with mild to moderate obstruction of the pulmonary artery.In a national study,865 of patients had no significant increase in their pressure gradient over a 4 to 8 year interval.Those with a significant increase were less than 4 years old and had at least moderate narrowing initially.Even mild obsruction may progress significantly in some infants in the first year of life. The prognosis of those with severe obstruction without surgery is poor, especially in infants with critical obstruction.Among the 580 patients alive at the completion of the above referred to study, new data were available on 464.The probability of 25 year survival was 95.7% compared with an expected age- and sex- matched control group survival of 96.6%.97 % were asymptomatic. There was no stenosis(narrowing) in 2%,mild in 93%, ,moderate stenosis in 3% and severe stenosis in only 1%. RJM

E-mail received:

I was recently hospitalized with symptoms of shortness of breath, sweating and a clammy feeling and heaviness in the chest area. I has several ekg's and chest xrays, which all were normal. I also had a cardiac catherization, which showed no blockage. A pulmonary doctor saw me and several pulmonary function test were performed. They too turned out normal. I am out of the hospital now but still have the same symptoms. My mother died at the age of 58 from cardiac arrythmia. I was put on a low fat, low cholesterol, low sodium diet. I am overweight so the doctor is saying that it is probably due to the weight, but I have always been heavy and have never had this problem before. I am still very concerned that something is being missed. What can you possibly attribute these symptoms to? I have follow-up appts. with the cardiologist and pulmonary doctor and I really feel that there is something else going on. What suggestions of information do you have that can be helpful?

Dr Matthews response:

What about age, family history, your lipids, thyroid tests, blood sugar,stress in your life (both emotional and physical,business, family conflicts, ladies, drugs, your abilityy to cope), exercise echocardiogram,24 hour Holter test, current exercise program and your discipline to it! RJM

E-mail received:

Dear Dr Matthew I have had a caesarian section a hysterectomy and a laparoscopy operation in my tummy. I started to have excruciating tummy pains with pains going up through my chest and neck veins. I get breathless on exertion and extreme fatigue cold abdomen and cold heavy legs and terrible throbbing pains in my head. The left side of my head has pins and needles and numbness and severe pain, I have unexplained dizzy spells I was told these symptoms was fibromyalgia. I had a stress mill test and it was stopped as I was so fatigued and breathless I was found to have a systolic heart murmur on the left sternal edge. The echo scan was done and the heart muscle was okay. The cardiologist said everything was okay and I never heard anymore. I went to my doctor on wednesday and I told him of my excruciating abdomen chest and leg pains. When he examined my abdomen he discovered the muscle in my abdomen is split open, he pushed his hand through the cap. I have spider mottled marks all over my skin and I told him I felt I had a circulation problem going on. I can feel a swelling just above my navel and I feel my aorta pulsating, I never felt this before even though I am small built. my abdomen is very swollen. He put me onto an aspirin one a day and naftidrofuryl oxalate. I have asked him to send me to another cardiologist to be reassessed as I feel very ill indeed. Can you please give me some advise as I feel all these symptoms are connected. I cannot leave the house in cold weather as it brings on excruciating pain in my lower extremities with chest, neck arm pain and very breathless What would be the best test for me to ask the cardiologist to run to help determine where the problem is lying. Is there a test you can look at all the artery and blood vessels in the tummy while scanning to see if there is something blocked. I would appreciate any advise you can offer me. Sincerely kind regards Heather from Scotland

Dr Matthews response:

You could see a lung specialist re your shortness of breath.Also,a CAT scan of the chest (or a MRI) could help to study for blood clots in your lungs ( a radioactive scan of your lungs might be best for blood clots!).As far as the abdomen is concerned, the abdominal muscle separation, diastasis recti, is fairly common and usually not a problem. A CAT or MRI of the abdomen may be beneficial to look for abnormalities like masses. For ruling out a blood clot in your inferior vena cava or femoral vein you may need an angiogram (or Doppler study) to prove this(with the clot going from your leg to your lungs! Why don't you see a gastroenterologist re your abdominal pains? He would know how to solve some of your problems! The head pains sound like a neuropathy or a type of of migraine! How are you handling stress and anxiety? Perhaps, you need a 24hour ECg Holter test to study you cardiac rhythm! RJM

E-mail received:

Dear Dr., I have had a pounding heartbeat since November of 2001. It seems to be related to food (sweets especially). It sometimes starts up about one hour after meals. I don't drink caffeine or eat chocolate. I don't smoke or drink alcohol either. I have been to many doctors, but none have found anything. I have had 3 EKG's, an echo, 48 hour Holter monitor (7 extra beats in 2 days), and heart cath (due to a false shadow on my myoview stress test). All have been normal. My blood pressure is 120/80, pulse is about 80, and my cholesterol is at 240 (started on Lipitor, 10mg, now it is down to 150 after 2 months on Lipitor). My doctor initially started me on propranolol (60mg/day). Then he increased dose to 80 mg/day to calm things down, but that didn't seem to help much, if at all. He then started me on Buspar for anxiety but it seemed to make everything worse. I am currently trying Prevacid for GERD. This seemed to work for the first week but last night I couldn't sleep. I feel my pulse so strongly in my neck and hear it in my ears. It won't let me sleep. I am scheduled for an upper GI on May 23, 2002. I'm pretty sure that will not turn up anything. What do you think I should be checking? I just read on the internet about pulsatile tinnitus. Is this a possibility? It seems like my main problem is in my neck and ears. The feeling of my pounding heart only comes now when I eat something like sweets (which I haven't done in over a month) but the sensation of the pulse in my neck and hearing it in my ears is still very much a problem. Any suggestions would be so greatly appreciated.

Dr Matthews response:

A 5 hour glucose tolerance test for posprandial hypoglycemia and diabetes mellitus may be in order,as well as a thyroid function study for hyperthyroidisn. Have you stopped drinking soft drinks with catteine and I trust you are not smoling grass!Have you tried drinking more fluids and increasing your intake of salt. How old are you! What is your tolerance for stress, emotional and otherwise? Any unhappiness lately? There are other drugs, which can be used for your symptoms@I doubt that your ears are involved! RJM

E-mail received:

Dear Dr., Thank you so much for responding. I am 31 years old. I had never been affected by stress in the past that I can remember. I don't think my symptoms are caused by stress or anxiety, but they definitely get worse with stress. I have stopped drinking all soft drinks and don't ever touch caffeine anymore. I don't smoke either. I have had many blood tests done and they are all normal (thyroid and glucose levels included). I have never had the glucose tolerance test though. My doctor told me they don't do that anymore. Is this true? I have increased my fluid intake (I drink lots of water now). I haven't increased my salt intake. How could that help? What are the drugs that you say could be used to treat my symptoms. I sure would love to get back to normal at some point. It has been a long, scary road and not getting much sleep just worsens everything. Thanks again for your e-mail response.

Dr Matthews response:

Yes! We still use glucose tolerance testing as I recommended in internal medicine and endocrinology!. Yes, increasing your salt intake may be helpful by helping to increase your fluid balance and prevent orthostatic hypotension, which be a cause of your symptoms! A tilt test of your blood pressure and pulse rate might be helpful! Other cardiac antiarrhythmia might be explored by your cardiologist including stronger beta blockers! Perhaps you should cover all bases and have a pyschiatrist consult re stress and anxiety! RJM

E-mail received:

I had heart surgery in January 2001 for an aneurism in the atrial septum. The surgery went ok. Now I have terrible weakness and breathlessness with the slightest exertion. My cardiologist doesn't seem to know why. The last echocardiogram showed quite a bit of leakage through the tricuspid valve. The cardiologist doesn't think this could be the reason, although having research on the internet, I think this could be indicative of pulmonary valve troubles. Monday, April 1, I see him again, and if he doesn't have a diagnosis or solution then, I think I will ask to go somewhere for furthur study. I'm in Hot springs, Arkansas. Do you think the Texas Heart Institute or the Methodist Dianostic Center famous for Dr. Debakey, both in Houston, would be good? Can you think of a better place for diagnosis and treatment. I am now almost totally handicapped--can't go shopping, to church, anyplace. The slightest exertion has me panting and groping for breath. I'd be glad for any light you could shine on my problem. Thanks!

Dr Matthews response:

Both places sound very good to me.You may need another heart catheterization and a transesophageal echocardiogram to define what is wrong! The aneurysm of the atrial septum sounds like an aneurysm of the sinus of Valsalva,protruding into the right atrium or the ventricle. Sometimes they rupture into these chambers! Please keep in cotact and let me know of your progress!It sounds as if you are in congestive heart failure.Certainly, Increasing pulmonary pressures can lead to tricuspid valve regurgitation. RJM

E-mail received:

Dear Dr. Matthews: Thank you for your site. I have been diagnosed with coarctation of the aortic artery. I have had three previous heart surgeries 1964 aortic repair 1981 mitral valve repair 1989 heart transplant. Three years ago I was diagnosed with my current condition. I am 50 years old. These are my symptoms Cold and cramping legs and feet, episodes of gout, tingling and numbness in left arm with blood pressure differences being left arm 174/88, right arm 154/90. great fatigue, rapid and irregular heart beat, sharp pains in the head, swelling in the abdomen as much as 8 lbs. a day. Angina even at rest on occasion and shortness of breath upon any exertion. Also lately I feel like I am going to pass out when I stand up or start to do something suddenly. I am taking cyclosporine, cellcept, monopril, lasix, vitamin E, calcium magnesium supplements, vitamin and mineral supplements, aspirin, allupurinol, lipitor, and synthroid. I have opted for no further surgical intervention. I am OK with dying but I would like to know what the usual age expectancy is for someone in my condition. Please be frank and honest. I have had more than enough hedging by my own doctors concerning this issue. Thank you so much for the chance to talk with you by email. I await your answer.

Dr Matthews response:

I need much more information to answer the question you have asked and surely your physicians are in a far more informed state to give you the best answer! Just why did you need surgery in 1964, 1981 and 1989? Did you have congenital heart disease previously? Was a lesion missed until 1989? It is remarkable that you have done well for 13 years after the transplant! What is the difference in BP between yourarms and feet and legs? This difference is the reason for the cold ,cramping lower extremities and the faint like symptoms on standing? Have you had angiograms to investigate the coronary arteries for lesions, which might be treated with stents and angioplasty or surgery? Was the coarctation discovered by angiography in 1999 and was surgery offered? Exactly where is the site of the stricture located in the aorta (is it where the transplant was sutured to the aorta)? IF surgery was offered, why give up? Why not keep trying? What is being done for the arrhythmia? has radiofrequency ablation therapy been suggested? Have you had a cardiac electrophysiologic study of the cause of the rapid heart beat (what did the cardiologist call the arrhythmia)! The abdominal swelling:is it due to heart failure or?? The cyclosporine and the cellcept may have a relation to the gout and the fatigue(have you had a TSH titer to learn if you are takig enough thyroid) RJM!

E-mail received:

Thank you for responding so quickly. Now to answer your questions in the order you asked them. Yes my physician could answer my question but he chooses not too. I think he is upset with my decision to forego surgery. Yes I had congenital heart disease. I was born with a "hole in the heart" and in early childhood I had scarlet fever. No lesions were missed. I do not know the difference in the BP between the legs and arms only that I am having these symptoms plus my doctor tells me that there is a difference between the two BP's. I have had many angiograms and it was the last one three years ago that determined the diagnoses of the condition that I am now coping with. Surgery was recommended but when my husband and I went to consult with the surgeon he advised that the risks in my case were very high. It was at that point that I decided I would opt not to have the surgery. About a year after heart transplant I developed problems which led them to perform a balloon coarctoplasty at that time. It helped until three years ago when the symptoms started to appear again. They informed me at that time that they would not do the coarctoplasty again. The stricture is at the top of the heart leading to the neck. I have a very swollen neck and visible palpatations at that site. Why not keep trying you ask. I respond by saying that each persons tolerance level is different and believe me when I tell you that I reached mine during heart transplant. I was in hospital 90% of a whole year waiting for transplant and it was not pleasant plus I had a very poor prognosis after transplant and spent 7 weeks in intensive care fighting for my life post transplant because the liver and kidneys would not respond to treatment. I nearly died at that point. The abdominal swelling is due to left heart failure and is quite severe. Nothing is being offered to control the arrhythmia. I do not know what kind of arrhythmia it is and no tests have been conducted to date concerning this symptom. I am monitored every six months for all my necessary levels including thyroid. I hope this answers your questions. Sincerely

Dr Matthews response:

What a brave woman you are! You certainly have been through a lot of suffering! But to live and be with your family has been worth it! I wish you would consult other transplant surgeons regarding the repair of the coarctation at a big center, where numerous transplants and coarctation repairs are performed! Maybe, the surgery could be done with less risk! I know you didn't ask me about further consultation, but I just had to do it! Otherwise, the prognosis is grim! No one can say how long you'll live with this current condition (already 3 years), but left heart failure is very serious and might be treated if the resistance to flow and increased work were removed by correcting the aortic stricture! It's a chance and life is still worth living (even if it is bitter-sweet)! Sincerely,RJM

E-mail received:

Dear Dr. Matthews: Thank you for your reply but you have not yet given me a satisfactory answer to my original question which was what is the average life expectancy for people diagnosed with adult onset coaractation of aorta. I know this is a hard question but I would not have asked it if I did not sincerely wish for an answer. I await your reply. Sincerely

Dr Matthews response:

In the area before surgical intervention,about 50 % of patients with coarctation died within the first three decades, and 75% were dead by age 50. Death was most frequently caused by a complication of hypertension such as stroke or aortic dissection, but other causes included endocarditis, endarteritis and congestive heart failure. In a study of 646 patients with coarctation operated upon between1946 and 1981 (age 1 week to 72 years) with 72 patients (11%) over the age of 35 years, the survival was good (91% at 10years, 72% at 30 years. The median age at operation was 16 years. The mean age of death was 38 years, confirming the previous findings that life expectancy is reduced for patients, even after repair. In this and other series reporting long term follow-up, the most common cause of death was premature coronary artery disease with secondary myocardial infarction (I believe you indicated that you are experiencing angina and may already have had a myocardial infarction). Other causes included congestive heart failure, stroke, and ruptured aortic aneurysm. Age at operation was a powerful prognostic factor. The older the patient, the greater the probability of premature death, making it highly likely that of preoperative obstruction and hypertension is important in the etiology of arterial disease and subsequent cardiovascular even.

E-mail received:

Dear Dr. Matthews; Thankyou for answering my question. I appreciate the information. God bless you for being willing to offer your information through the internet. What a marvelous thing technology is. Thank you again.

E-mail received:

I had an ASD operation 1 1/2 years ago and I was wondering it this was considered a disease. I also have mitral valve proplase and pulmonary hypertension. Do you know of any health insurance that would possibly insure someone with this? I am having trouble getting insurance. Thank you.

Dr Matthews response:

Yes, an atrial septal defect is a congential heart disease. Mortality in patients over 40 years approaches 5%. Long term prognosis for a normal life expectancy and functional capacity is excellent for patients having closure of an uncomplicated atrial septal defect during the first two decades of life. In the absence of adequate long-term survival data for many operated and unoperated congenital heart lesions,life insurance may be difficult to obtain for many young adults. In 1986 only patients with very simple lesions were insured at regular rates.These included mild pulmonary stenosis,uncomplicated corrected atrial septal defect,and ventricular septal defect and patent ductus arteriosus.RJM

E-mail received:

My mother in law was told that she has the left ventricular chamber enlarged and that she also has hypokinesia of all walls of her heart with exception of the anterior wall with an ejection fraction calculated at 35 percent. Could you please explain the risks and maybe possible treatment.She is 72 years old. She has a pacemaker for 3 weeks now.Thank you very much for your help.

Dr Matthews response:

What is the underlying cause of the heart condition? Please see on my website definitions: 1)http://www.rjmatthewsmd.com/Definitions/congestive_heart_failure.htm
2)http://www.rjmatthewsmd.com/Definitions/heart_failure.htm
If after reading this material you have questions, please do not hesitate to contact me.rjm

E-mail received:

Dr Matthews, Thank you so much for your help.

E-mail received:

My granddaughter who had her 15th birthday in December has just been diagnosed with a neurocardiogenic condition. At birth she had a breathing problem (a few weeks premature birth). She has had asthma all of her life and was diagnosed with Lupus at age 11. This week she had a seizure. The pediatrician sent her to Neurologist. This doctor wants her to also see a Pediatric Cardiologist. She will see that doctor and will have some diagnostic procedure in hospital in a few days. Her Mom was told that this problem has to do with the heart not pumping enough blood to the brain and something about the right ventricle. He said that this condition sometimes develops for people who have autoimmune diseases. He used the term Cardiogenic arrhythmic dysplasia. Is this a correct term? Or is there a similar term that we have misunderstood? Can you tell us anything about this condition? The neurologist indicated that it can be treated but that she would not be able to participate in certain activities (such as driving). The child is understandably upset. She has commented, "every time I see a new doctor, they give me a new disease!". We will appreciate any information you can furnish about this condition. None of the family has ever heard of this condition.

Dr Matthews response:

You should tell me more about what the cardiologist found on his studies, especially the echocardiogram. Did she have an electrophysiologic electrocardiographic study of her heart rhythm?Also she may need a 24hour ECG holter test to see if there is an arrhythmia present! From what you have e-mailed me, it sounds like your grand daughter has had an episode of ventricular tachycardia, a condition in which the heart beats so fast that it is ineffective in delivering blood to the head,resulting in fainting and seizure(hence unsafe to drive)! There are drugs to treat such a condition.And when the drugs are not effective,one can use an implantible cardiac defibrillator. Arrhythmogenic right ventricular dsyplasia(ARVD) is commonly associated with nonsustained or sustained ventricular tachycardia. It reportedly has a low mortality rate.Pharmacologic and surgical approaches have been used for its management.Amiodarone and classIC drugs have been suggested to be effective for ARVD patients with symptomatic arrhythmias. Sustained ventricular tachycardia is also associated with isolated right ventricular cardiomyopathy, which may be an extreme form of ARVD but has a significantly higher risk of lethal arrhythmias. Incidentally is she hard of hearing? Please read onMy website the following on ventricular tachycardia(http://www.rjmatthewsmd.com/Definitions/ventricular_tachycardia.htm). Let me know the outcome of the tests!RJM

E-mail received:

I have many questions and will try to ask one at a time with the information I have been given. I have been told that I had a heart attack in late Nov. 1998. The only symptom I had for a few weeks was shortness of breath. For several weeks I had been going to see the Family Physician at least once a week with the "can't breathe complaint".I'd had a sinus infection earlier. My Family physician did an EKG in office, sent me for chest xray and prescribed an antidepressant. I really didn't feel that I needed an anti-depressant but did as ordered. I took the antidepressant for about 2 days, and in early am went to ER in EMS. Apparently nothing showed up in the one test the hospital performed. I was in Critical Care Unit for a week and spent another 7 days in a hospital room. I remember very little about the ER but was told the ER doctors saved my life. When I was dismissed from hosp., oxygen was ordered for me but after 8 months I had not used even a full tank. But I did begin to swell and gain weight. Gaining 2-3 lbs/day, the Pulmonary Dr. prescribed diuretics which did not work very well. This is when I began to need the oxygen. He then asked if I had a Cardiologist and made an appt for me to see one. The very nice cardiologist did several tests, EKG, ultrasound, Echo Chamber and had me get a heart cath. A different Dr. did the Cath test. He confirmed what the 1st dr. had told me. "One main artery totally blocked and an aneurysm in the wall of left ventricle" . My cardiologist suspected that happened during the heart attack. The doctor who performed the cath test was matter-of-fact in his manner and told me I should forget that artery, it had done its damage and there was nothing they could do about it. I asked,"does this mean I will continue to gain 2-4 lbs/day for the rest of my life?" He responded, "Don't know. Maybe so". Since this problem developed, my heart rate is much more rapid. Initially, the cardiologist prescribed the digoxin, Vasotec and nitroglycerin. Several physicians have taken the rate with machines and wrist pulse rate at different times. Lying down the heart rate runs around 110-115. When I stand and walk a short distance it goes to 130 and +. Two physicians prescribed several things to help heart rate (Vasotec, Prinivil, Diovan, etc in the same family of medicines) but I had such side effects they discontinued. My "nice" cardiologist told me that my heart beat sounds like a gallop (a biddle-de-bop sound). I have never had high blood pressure and do not have high cholestrol. When the nurses and/or doctors take my BP they usually comment that they would like to have my readings. I saw another cardiologist when I had swelling (edema) in my right leg and foot but not in the left. Had edema in mid section and right side. I asked the doctor what caused it and why only that one leg and foot (the foot was twice its size). He replied, " I have no idea"...told me to reduce my intake of Lasix to 20 mg/day and come back in 3 months. I tried to obey his orders but began to swell more and gain more each day. His attitude was one that impressed me as being "why are you bothering me". He had my records in front of him during the visit., showing the results of various tests. Do I really have a problem to be concerned about - since some doctors act as if it isn't a problem at all? One of my doctors (a specialist in another field) told me that some cardiologists think that as long as the heart is beating at all it is OK. I usually don't consult a doctor at all unless I feel very bad and can barely move at all. I do not call or see them about every little problem. Several times when I had a terrible time breathing and called the Pulmonologist. His nurse would tell me to call my Cardiologist because it was a heart problem. These kinds of things make me wonder - what??? Who does one see? The only doctor who has noted my symptoms and tried to help stabilize my condition is a nephrologist. Now that I am "stable" I don't get to see this doctor anymore. I have continued to be plagued with edema altho' I take Aldactone 100 mg, Lasix 80 mg and Zaroxolyn 2.5 mg combination. The only heart medication I take is 0.125 mg Digoxin/day. And I take 1 Ecotrin/day for blood thinner. I am 68. Had taken no medication except 90 mg Armour thyroid for 45 yrs. and occasionally something for sinus infection and allergy until this problem developed. I have gained a lot of weight and cannot get exercise because standing/walking I get out of breath quickly, and feel as if I have run the marathon after only a few steps. When I sit or lie down I do not have a problem with breathing. I had a stress test on a bicycle and did fairly well but cannot do the treadmill, etc. At present I am not seeing a cardiologist on a regular basis. I did have a kidney angiogram which was normal. I have seen a couple of cardiologists who have indicated that I could make another appt "if I wanted to" but didn't seem too concerned if I did or not. I do not understand if I have a serious condition or if I should just forget it and hope for the best. The only advice I was given was "do whatever you feel like doing"...Do you have any advice to help me to feel more human? I really miss not being able to do my housework and yard work. I can still accompany the choirs at church (that is a sitting position). but I am much more dependent on others that I would like. I will be grateful if you have any helpful advice for me - or recommend a cardiologist I could see in person. My sincere gratitude for your time and help.

Dr Matthews response:

Of course, it is difficult to know exactly what is your problem without having all the records and examining you. Nevertheless, it sounds like you do have congestive heart failure secondary to the damage from the heart attack.You should try the medicines again, but in a smaller dose or find a substitute(of course you would need to ask the cardiologist). Also, ask if he would consider a bypass coronary artery procedure on you or an angioplasty or stent?Or are you a candidate for a transplant? Please read on my website the following:http://www.rjmatthewsmd.com/Definitions/congestive_heart_failure.htm and http://www.rjmatthewsmd.com/Definitions/heart_failure.htm Please keep me informed!RJM

E-mail received:

My father recently was diagnosed with acs. He had one clogged and the other two ballooned out. What are we to expect over the next year with future heart related problems and could you explain acs in easier terms.

Dr Matthews response:

The abbreviation escapes me,but apparently is related to coronary artery atherosclerosis with symptoms of angina pectoris(chest pain).Can you tell just what you mean by "acs"? How old is your Father? What were or are his symptoms? What is his cholesterol LDL, and HDL? What is the clogged artery(right or left)? Does "ballooned out" mean that he had a percutaneous coronary artery angioplasty?What is his heredity? does he smoke? Is he overweight? Does he have Diabetes? Is he on statin drugs and aspirin? What is his blood pressure? Has he had an actual heart attack? What are his symptoms?Is he short of breath,etc? Answers to these kind of questions can help give you his prognosis.RJM

E-mail received:

I have soreness in the left side of my chest. No pain, just soreness, that if it were anywhere else in my body I wouldn't be worried about. If it were anywhere else I'd assume I strained some muscles. I can run three miles and have no trouble breathing, no pain,etc. What might the problem be. thanks

Dr Matthews response:

It may still be a chest wall strain of muscles, ligaments cartilages, bones etc secondary to some prior physical activity.Or it may represent an inflammation of the chest wall.Certainly if it does not clear up ,you should consult a physician for a physical examination,chest film,ECG and other tests.How old are you? have you had a recent physical, cholesterol, blood sugar check, What is your family history? Do you smoke?RJM

E-mail received:

I am doing research for a term paper and I have not been able to find some information. Would you know what the difference for the following would be? * MI, mild MI and mini MI * Stroke, mild stroke and mini stroke If you have any feedback please reply to this e-mail. Thank you in advance!

Dr Matthews response:

I'll try to help,hoping that you have read the the definitions I referred to you. 1)An "MI" refers to the results of a coronary artery being completely occluded by an atherosclerotic plaque.This occlusion deprives the heart muscle of oxygenated blood,which leads to the death(necrosis) of the muscle,which is critically dependent on that occluded artery to supply it with oxygen! The area of death is determined by the number of other arteries(collaterals) supplying the same area of muscle.If this area is totally dependent on the occluded,major vessel ,then all of this area will die.If the area is small,and does not cause major derangements in pulse,rhythm,and blood pressure,then it may be classified as as a mild or small myocardial infarction,especially if it is does not involve the entire thickness of the heart wall and does not produce certain ECG findings like an abnormal "Q" wave complex (a subendocardial location). Subendocardial location means the area just under the endocardium (which is the lining of the inside of the heart,as opposed to the epicardium covering the outside of the heart). A through and through infarction from the endocardium to the epicardium usually produces "Q" waves on the ECG and is more serious, as it implies a more extensive area of death(necrosis of of the myocardium). Regarding strokes,the cerebral arteries supplying oxygen via the blood are involved, usually with atherosclerosis and hypertension causing occlusions, hemorrhage, or embolus. A major stroke involves necrosis to a significantly large area of the brain to cause paralysis of various structures such as an arm and/or leg etc. usually without total reversibility. On the other hand, total reservibility can occur if an area is very transiently deprived of blood for a few seconds or a minute or so:e.g.,transient blindness,dizziness, numbness, weakness as symptoms.RJM

E-mail received:

Dear Dr Matthews, I cam e across your site today while searching for some information on Warfarin and diet, and hope you can help. Just over a year ago, my father ( aged 74) was diagnosed with a too rapid heart beat. He was in hospital for about a week, and was prescribed warfarin. He was told that this was necessary to get his blood to the right consistency to have electric shock treatment to correct the problem, and was told to expect the drug to take about three months to get things to how they should be. He has been going to have his blood tested every three weeks or so, and the consistency has been up and down like the proverbial yo-yo. He still has not had the shock treatment. The dosage has been altered several times - he's had nose bleeds that won't stop, and blood in his urine etc. A family friend, who is a nurse, has told us that diet can affect Warfarin, though she gave no details. I wonder if you are able to give me any information, or point me in the right direction, please? My father is as healthy otherwise as a man of his age can be, but hates taking drugs and is therefore getting a bit frustrated. I hope you can help, and look forward to hearing from you. Yours sincerely,

Dr Matthews response:

It is important to not take any other medication including aspirin and other over the counter ones,and herbal products, except on advice of the physician. Avoid alcohol consumption.The amiount of vitamin K in food may affect therapy with warfarin. Eat a normal, balanced diet maintaining a consistent amonut of vitamin K.Avoid drastic changes in dietary habits, such as eating large amounts of green leafy vegetables, since they contain lots of Vitamin K ,which anatagonizes warfarin. Incidently, the tests of the warfarin's effects may have to be more frequently to better control the prothrombin time and to get a steady effect of the warfarin.RJM

E-mail received:

Dear Dr. Matthews: Thankyou for your site. I have been diagnosed with coarctation of the aortic artery. I have had three previous heart surgeries 1964 aortic repair 1981 mitral valve repair 1989 heart transplant. Three years ago I was diagnosed with my current condition. I am 50 years old. These are my symptoms Cold and cramping legs and feet, episodes of gout, tingling and numbness in left arm with blood pressure differences being left arm 174/88, right arm 154/90. great fatigue, rapid and irregular heart beat, sharp pains in the head, swelling in the abdomen as much as 8 lbs. a day. Angina even at rest on occasion and shortness of breath upon any exertion. Also lately I feel like I am going to pass out when I stand up or start to do something suddenly. I am taking cyclosporine, cellcept, monopril, lasix, vitamin E, calcium magnesium supplements, vitamin and mineral supplements, aspirin, allupurinol, lipitor, and synthroid. I have opted for no further surgical intervention. I am OK with dying but I would like to know what the usual age expectancy is for someone in my condition. Please be frank and honest. I have had more than enough hedging by my own doctors concerning this issue. Thankyou so much for the chance to talk with you by email. I await your answer.

Dr Matthews response:

I need much more information to answer the question you have asked and surely your physicians are in a far more informed state to give you the best answer! Just why did you need surgery in 1964,1981 and 1989? Did you have congenital heart disease previously? Was a lesion missed until 1989? It is remarkable that you have done well for 13 years after the transplant! What is the difference in BP between yourarms and feet and legs? This difference is the reason for the cold ,cramping lower extremities and the faint like symptoms on standing ?Have you had angiograms to investigate the coronary arteries for lesions,which might be treated with stents and angioplasty or surgery?Was the coarctation discovered by angiography in 1999 and was surgery offered? Exactly where is the site of the stricture located in the aorta(is it where the transplant was sutured to the aorta)? IF surgery was offered ,why give up?Why not keep trying? What is being done for the arrhythmia? has radiofrequency ablation therapy been suggested? Have you had a cardiac electrophysiologic study of the cause of the rapid heart beat(what did the cardiologist call the arrhythmia)! The abdominal swelling:is it due to heart failure or?? The cyclosporine and the cellcept may have a relation to the gout and the fatigue(have you had a TSH titer to learn if you are takig enough thyroid)RJM!

E-mail received:

Dear Dr. Matthews: Thankyou for responding so quickly. Now to answer your questions in the order you asked them. Yes my physician could answer my question but he chooses not too. I think he is upset with my decision to forego surgery. Yes I had congenital heart disease. I was born with a "hole in the heart" and in early childhood I had scarlet fever. No lesions were missed. I do not know the difference in the BP between the legs and arms only that I am having these symptoms plus my doctor tells me that there is a difference between the two BP's. I have had many angiograms and it was the last one three years ago that determined the diagnoses of the condition that I am now coping with. Surgery was recommended but when my husband and I went to consult with the surgeon he advised that the risks in my case were very high. It was at that point that I decided I would opt not to have the surgery. About a year after heart transplant I developed problems which led them to perform a balloon coarctoplasty at that time. It helped until three years ago when the symptoms started to appear again. They informed me at that time that they would not do the coarctoplasty again. The stricture is at the top of the heart leading to the neck. I have a very swollen neck and visible palpatations at that site. Why not keep trying you ask. I respond by saying that each persons tolerance level is different and believe me when I tell you that I reached mine during heart transplant. I was in hospital 90% of a whole year waiting for transplant and it was not pleasant plus I had a very poor prognosis after transplant and spent 7 weeks in intensive care fighting for my life post transplant because the liver and kidneys would not respond to treatment. I nearly died at that point. The abdominal swelling is due to left heart failure and is quite severe. Nothing is being offered to control the arrhythmia. I do not know what kind of arrhythmia it is and no tests have been conducted to date concerning this symptom. I am monitored every six months for all my necessary levels including thyroid. I hope this answers your questions. Sincerely

Dr Matthews response:

What a brave woman you are!You certainly have been through a lot of suffering!But to live and be with your family has been worth it! I wish you would consult other transplant surgeons regarding the repair of the coarctation at a big center, where numerous transplants and coarctation repairs are performed! Maybe, the surgery could be done with less risk! I know you didn't ask me about further consultation,but I just had to do it! Otherwise,the prognosis is grim!No one can say how long you'll live with this current condition(already 3 years), but left heart failure is very serious and might be treated if the resistance to flow and increased work were removed by correcting the aortic stricture!It's a chance and life is still worth living(even if it is bitter-sweet)! Sincerely,RJM

E-mail received:

Dear Dr. Matthews: Thankyou for your reply but you have not yet given me a satisfactory answer to my original question which was what is the average life expectancy for people diagnosed with adult onset coaractation of aorta. I know this is a hard question but I would not have asked it if I did not sincerely wish for an answer. I await your reply. Sincerely

Dr Matthews response:

I simply do not have the statistics for this complication,But I'll ask others and see if I can get the answer!RJM

In the area before surgical intervention,about 50 % of patients with coarctation died within the first three decades, and 75% were dead by age 50.Death was most frequently caused by a complication of hypertension such as stroke or aortic dissection,but other causes included endocarditis,endarteritis and congestive heart failure. In a study of 646 patients with coarctation operated upon between1946 and 1981 (age 1 week to 72 years) with 72 patients(11%) over the age of 35years, the survival was good(91% at 10years,72% at 30 years.The median age at operation was 16 years.The mean age of death was 38years,confirming the previous findings that life expectancy is reduced for patients, even after repair. In this and other series reporting long term follow-up, the most common cause of death was premature coronary artery disease with secondary myocardial infarction (I believe you indicated that you are experiencing angina and may already have had a myocardial infarction). Other causes included congestive heart failure, stroke, and ruptured aortic aneurysm.Age at operation was a powerful prognostic factor.The older the patient, the greater the probability of premature death, making it highly likely that of preoperative obstruction and hypertension is important in the etiology of arterial disease and subsequent cardiovascular events.RJM

E-mail received:

Dear Dr. Matthews; Thankyou for answering my question. I appreciate the information. God bless you for being willing to offer your information through the internet. What a marvelous thing technology is. Thankyou again.

E-mail received:

I am writing to you for advice. My father is 72 years of age and 2 weeks ago he suffered a heart attack and stroke. 2 days prior to this he was feeling ill and complaining about poor vision. Over the 2 weeks his condition has been one of gradual decline. 2 days ago the Hospital doctor has diagnosed endocarditis. He is now blind, has no coordination, no short term memory, and can although he can still talk, does not seem to understand anything, and his answers are short and repeated. He is being treated with high doses of antibiotics and steroids. Could you please give me an honest opinion of his chances of recovery, and the level of recovery he can expect.

Dr Matthews response:

It sounds like your Father may have had infective acute or subacute endocarditis 2 days prior to the heart attack and stroke, when he was not feeling well and suffered poor vision due to emboli(from infected vegetations in the left heart chamber) to the the retinal arteries.The heart attack and stroke may have been due to emboli to the coronary and mid-cerebral arteries leading to infarction of the heart and the brain. Favorable prognostic factors include youth,early diagnosis and treatment,and penicillin-sensitive streptococcal infection.The prognosis is good for many yuong injected drug users with staphylococcal auerus infection of the tricuspid valve. Eradication of the etiologic organism can be achieved in a high proportion of all patients with bacterial endocarditis, But both the early and long term mortality rates remain significant because of preexisting disease and damage already caused before infection is eradicated.Survival curves after admission with infective endocarditis show a significant number of late deaths despite microbiologic cure.Analysis of experience over the past 20 years permits a reasonably accurate formulation of the the prognosis for microbiological cure among the various subgroupss of patients with infective endocarditis (see attached table). Varying degrees of neurologic recovery from a stroke due to a thrombosis secondary to atherosclerosis can continue up to six months after the event! You should talk to your Father's neurologist and infective diease consultant!RJM

E-mail received:

Sir, Thank you for your kindness in replying to my email. Unfortunately Dad has not responded to the antibiotics, and the laboratory has been unable to grow the particular strain that is affecting Dad, and so target the specific bug. As a result Dad has had several more strokes, and has not been conscious for 4 days or so. Sadly we are waiting for the end, the treatment has stopped, and all we can do is hold his hand and wait for the inevitable. Sincerely,

Dr Matthews response:

I 'm very sorry to heard of the situation!I 'm certain you consulted an infectious disease consultant?RJM

Dr Matthews response:

Thank you again for your correspondence. Dad passed away last Friday. He will be cremated this Friday. The microbiologists were unable to cultivate the bacteria and so we may never know the cause of the endocarditis. His death certificate reads, cerebrovascular accident, and unknown bacterial endocarditis. I have not contacted an infectious disease consultant, but have spoken to the Doctors that were treating Dad and I am sure that they have done all they possibly could regarding Dads illness. Once again, thank you for all your help and information. It is nice to know people like you are out there. Sincerely,

E-mail received:

Dear Dr. Matthews, I am a 21 year old male and this summer I got very lightheaded, tired and have nausea. I still feel this way today, I've had blood tests, a CT scan, and have been to an ENT to see if it was vertigo or an inner ear problem. All my tests came back normal except they discovered a rapid rate rate. The cardiologist found out I have atrial septal defect. I am getting surgery the 18'th of this month to fix it. They say the heart defect is responsible for my symptoms but can't really explain why, I was hoping you could help me understand how the heart is responsible for these symptoms because I am getting very nervous that they will fix my heart and I might still have these symptoms. Thank you very much for your time, I really appreciate it. Sincerely,

Dr Matthews response:

Please see on my website definition "atrial septal defect": http://www.rjmatthewsmd.com/Definitions/atrial_septal_defect.htm
As you can see the rapid heat beats do occur in atrial septal defect and cause symptoms similar to those which youhave experienced.One would anticipate that the surgery will alter the hemodynamics back to normal and hence the arrhythmias will be eliminated. Should they recur, there are medicines to prevent and other procedures to treat them!RJM

E-mail received:

Can you tell me what is an aortal disection and how is it treated?

Dr Matthews response:

Please refer to my website :http://www.rjmatthewsmd.com/Definitions/aneurysm.htm. Aortic dissection is a rupture of the inner lying (layer) of the aorta ,the great vessel leading out of the heart, with the blood under pressure going under the this lining to create a false lumen.Quite often the aorta can dilate at a weak point and such is called an aneurysm, which can dissect as previously described or can rupture!RJM

E-mail received:

Thank you for replying. Your definitions page has been very helpful and informative and in some ways reassuring as to the treatment which may be available.

E-mail received:

A year after having 4 by-pass surgery, I had a blockage in one of the by-passes. A procedure (I believe it is called an antherectomy) was performed. My question : is that just angioplasty or something else?

Dr Matthews response:

http://www.rjmatthewsmd.com/Definitions/angiogram.htm http://www.rjmatthewsmd.com/Definitions/directional_coronary_atherectomy.htm http://www.rjmatthewsmd.com/Definitions/equip-da.htm The above definitions on my web site should answer your question!RJM

E-mail received:

Dr. Mathews, I thank you in advance for clearing up some confusion I have. My father, M 60, non smoking or ETOH, athletic, weight, 165, suffered a MI approx. one month ago, he had no significant heart muscle damage, his ck-mb and troponin did not become abnormal , however the ecg reveiled a real MI. A stent was placed at this time. 2 weeks later he went back in with continuing angina and the doctor stated he has some blockage and placed 3 more stents. The second event is kind of strange in my mind, I am a 2nd year RN student and could not be present for his hospital stays because of finals. I was supposing the second event was because of significant angina??? 4 stents are irreversible, correct? I don't have the personal knowledge yet of the sequelae of these stents. What are the probable, statistical, future events??? Thank you,

Dr Matthews response:

Usually a myocardial infarction means there is or was significant muscle damage.Perhaps the CPK and Troponin evidence of damage was missed, while the ECG showed evidence that there had been muscle damage! At any rate,the stents were placed to allow more blood to get through the areas of narrowing of the involved coronary arteries.Yes, the angina pectoris or chest pain is why the stents were placed. These stents have a 20% to 30% chance of narrowing or occluding themselves by the ingrowth of endothelial tissue. Lately, it has been found if the stents are irradiated or medicated with anti-inflammatory medicines at the time of placement,there is a reduction in the number and degree of restenoses.RJM

E-mail received:

I am doing a science project on music and its effects on heartrate. I would like to know if there are any studies on this topic and if so, what do they show? Thank you.

Dr Matthews response:

I can recommend consulting medical school libraries for the data you seek. Depending on the effects of the music on the sympathetic and parasympathetic nervous systems as to whether it calms or excites the subject,one might expect changes in the heart rate,as more or less epinephrine,norepinephrine, cortisone etc are released.This response would be based on what the music meant to the individual, which may be variable from one to the next,due to past experiences.RJM

E-mail received:

Dr. Matthews: I am a Registered Nurse and have just visited your very informative website & would like to pose a few questions to you. I am 48 yrs.old (153 lbs, 5'3") and have been relatively healthy right along. About 2 yrs. ago I was diagnosed with borderline hypertension ranging from 140/85-90 to 160/90. Of course, various factors affect these readings such as stress, diet etc. I do not smoke, drink or abuse caffeine. I do not use table salt and watch/read sodium content in the foods I prepare and eat. I walk atleast 1 mile 3-4 times a week and also particpate in weight strengthening exercises. I take multiple vitamins, extra C, vitamin E, B-Complex, magnesium and eat a very healthy diet with 4-5 servings of fruit/vegetables and cereal (oatmeal) each day. I am in the "perimenopause" state & have begun to experience palpitations, especially notable through the nite. I recently had a physical and no mitral valve or murmur was noted. Some days, especially the last few months, I am very aware of my heartbeat. Is this related to the fluctuating hormone levels? Again, I am very active with a full time job and househole activities, so I am not completely sedentary. I am not taking any BP medication since I had untoward side effects and am trying to regulate it by diet, exercise, stress reduction, etc. My BP this morning in the right arm was 129/72, pulse of 76. I also starting taking CoQ10, 30 mg 1-2x/day since I read about it in several cardiac articles and books. Thank you for your time.

Dr Matthews response:

Please read on my website under "messages" where palpitations are discussed. You will find some of the answers there(http://www.rjmatthewsmd.com/Message/m.htm)! Also, look under "definitions"PVCs http://www.rjmatthewsmd.com/Definitions/PVCs.htm and http://www.rjmatthewsmd.com/FAQs/q.htm No,I do not think your symptoms are hormonal! RJM

E-mail received:

My mother had her valve replaced, september of 1997. She now has a mitrial medro valve (mechanical). At first it took a while to get her heart into rhythm. She had be shocked twice, it worked only for a short time. Then they administered her into the hospital and got it regulated with medication, Pacerone. About 6months ago she started lowering her medication because it was hurting her eyes. About 2months ago she was extremely exhausted all the time I noticed she was wheezing pretty bad so she went to the lung doctor and was diagnosted with a lung ingfection. and her heart is out of rhythm she cannot even walk to the restroom without stopping 3 times the heart doctorl claims that it was because of the lung infection. Lung doctor said their is a little black spot left. She is still wheezing very heavy and is extremely exhausted all the time something is really wrong this is not normal for my mother. Inbetween all this her heart doctor does not take her kind of insurance so she had to chance doctors which he doesn't really know her history. She was put into the hospital about one month ago to get her heart back in rhythm the medication was not working everytime they took her off her heart would go back out of rhythm. they electrical schocked her again that did work either. They still released her from the hospital.knowing that her heart was not in rhythm. Her lung doctor feels it is the heart the heart doctor feels it is her lungs. I will be going with her to the doctor on friday so I could ask some questions on what needs to be done to get my mom back in rythm. She is still wheezing very heavy and her heart in beating out of rhyhthm last time it was checked when she went to the hospital it was resting heart rate was 140 beats per minute. My mom is 59 yrs old.

Dr Matthews response:

What is the name of the arrhythmia from which your Mother suffers.Is it atrial fibrillation? Pacerone(amiodarone) is one of the medicines used to treat it.Has digoxin (a very reliable,older medicine) and atenolol(a beta-blocker) been tried to control the arrhythmia? Also, an electrophysiologic study of the heart rhythm may need to be done to determine if your Mother is a candidate for radiofrequency ablation of the irritable focus within the atria or pulmonary vein orifices! Why or what was the disease of the mitral valve necessitating surgery? Was it mitral stenosis or regurgitation? Has a recent echocardiogram been done? Was or is your Mother a smoker?Does she have asthma or emphysema, cuase of wheezing? Does she have congestive heart failure?

E-mail received:

I have had two heart attacks, six years ago tomorrow, and have a triglyceride level of 175. I need to know just what foods I can and cannot eat. My cardiologist explained this to me, but I am 65 years old and do not retain verbal information as well as I would like. Therefore, when I got home from my last check-up, I wasn't really sure just what he had told me. I think I received too much information at one time, therefore, I did not retain much. I would like to know if eggs are an approved food in my diet? I do know that bakery products, pastas, and food with added sugars are a no-no. Any information or where to obtain more information would be greatly appreciated.

Dr Matthews response:

The triglyceride level of 175 may be in the normal range,depending on your laboratory's normal range of values.So call your cardiologist and check on the normal values versus your values! Starches, sugars, sweets are some of the items to reduce the intake of, especially if you are overweight. Indeed you must get down to your ideal weight. You did not mention your cholesterol value, but the yellow of the egg should be avoided due to the cholesterol content(except on a rare occasion).You can have all of the white of the egg you want!You should avoid all the fatty skin of chicken etc fowl,bacon,butter, creams etc.You can use unsaturated margarine, nonfat milk, polyunsaturated cooking oils,fish,chicken etc. Call the hospital dietician and have a consulltation with her.I believe Medicare will pay for the consultation!RJM

E-mail received:

Thank you so much for your prompt reply and for the information. I will print it out so I can refer to it OFTEN, as I have difficulty remembering. My cholesterol is below 200. I am sorry to hear that I need to avoid the yolk of an egg, as I love eggs. I have had very few in the past six years, except on rare occasions. I had read an article in Reader's Digest stating that the American Heart Association now approved of one egg per day as it provides something that is supposed to protect the heart, maybe an antioxidant component? The yellow is the part I really like. Thanks again,

Dr Matthews response:

Yes,The yellow of the egg tastes so good,but in general it should be avoided:It is too rich in cholesterol,which leads to atherosclerosis of the coronary arteries.You can get your antioxidants else where!Don't believe every thing you read! I still think you should consult a certified dietician from your hospital.RJM

In view of your history of 2 heart attacks, why not take lipitor or even zocor,mevacor or pravastatin to help prevent further atherosclerosis, since these drugs have been shown to help even people with normal cholesterols(it reduces the incidences of heart attacks in these people with normal cholesterols ,maybe because they act to prevent inflammation ih the coronary arteries).The lipitor helps to reduce the triglyceride as well! Why not discuss this with your cardiologist!RJM

E-mail received:

My cardiologist is very thorough, but very cautious about adding a medication that might be a lifelong ordeal, as I believe one of the statins would be? I am very sedentary and probably should use more self-discipline in making sure that I exercise regularly. I will ask my cardiologist the next time I see him or maybe call him to see what he thinks about this. Thanks so very much for your information and suggestion

Dr Matthews response:

Use 2 egg whites to substitute for each whole egg.Youy'll save only 5 grams of fat(because eggs are fairly low in fat),but you'll save 213 milligrams of cholesterol for each egg yolk that you don't use. Pureed Prunes or baby food prunes work as oil and fat replacers in chocolate baked goods.For each half-cup of prune puree,you'll save nearly 800calories and more than 100 grams of fat. Marshmallow creme(as a substitute for margarine or butter in recipes) adds creaminess and no fat,but of course a lot of sugar. Applesauce can be used in baked products instead of oil,butter or margarine.You'll save more than 900 calories and 100grams of fat.In recipes where oil is the only liquid,try half apple sauce and half buttermilk. Use evaporated skim milk in stead of heavy cream in recipes!It tastes like cream and has a richer texture than regular skim milk.For every cup used in place of a cup of cream, you'll savve 80grams of fat and 600calories. Fat- free plain yogurt can be used in place of whole sour cream (unfortunately, fat-free sour cream doesn't have the rich body or favor of plain yogurt.You'll also get more calcium than you would with sour cream. You can get more information at e-mail daogar@wellnessletter.com RJM

E-mail received:

These were amazing to me. I had only heard about using the applesauce instead of oil. All the other suggestions were new to me. Thanks so much. If I reduce my cholesterol and calorie intake does that help lower the triglyceride level?

Dr Matthews response:

The answer is yes,if indeed you are over weight ,especially!Rjm

E-mail received:

My question has to do with language and how certain terms are used: 1. When referring to the left main and proximal artery, is it one artery that is being referred to or two arteries? 2. Is it correct to say "angioplasty and stenting of coronary stenosis"? Or should angioplasty and stenting refer to the particular artery where the procedure is performed-e.g., "angioplasty and stenting of the left main coronary artery"? I hope that you can clarify for me the correct use of these terms. Thank you for your time and assistance. Sincerely,

Dr Matthews response:

1.One artery(left coronary artery,whose takeoff from the aorta or trunk is called the left main(or indeed it is the most proximal portion) coronary artery,which branches into the left anterior descending coronary artery with its diagonal side branches and the left circumflex artery(review site http://www.rjmatthewsmd.com/Definitions/b_supply_ccsys.htm). 2.Angioplasty and stenting of the left main coronary artery is correct. Thanks,RJM

E-mail received:

I am a 51 white female 5'4" 115 lbs. on estrogen replacement therapy, have mitral valve prolapse and recent cholesterol of 268 (trglyceridess-141; HDL 80; LDL 160.My doctor wants to put me on Lipitor. I have been under a trememdous amount of stress over the last 6 months. My oldest son dropped out of school and ran away and my husband of 27 years left. Could all this stress adversely affect my cholesterol. I am considering watching fat grams in my diet and waiting for the stress level to decrease and then check the cholesterol again. I walk and do yoga -have not been as regular as I am starting to be now. Do I NEED to be on medication now.Family history: Father died of stroke at 70;mother alive at 85

Dr Matthews response:

Yes, I think you should do as your doctor suggest and start the lipitor, since stress would only contribute a little to the colesterol and your paternal family history is positive and you should get started soon!RJM

E-mail received:

What is meant by the term atrial quadragemina and where can I acquire more info on this condition,

Dr Matthews response:

I suspect that the term(quadrageminy) refers to the timing of the occurrence of the premature atrial contractions,such that the premature atrial beat occurs every 4th beat ,as opposed to bigeminy in which the extra beat occurs every second beat! Consult a book in a medical library on Electrocardiography!RJM

E-mail received:

Dear Dr. Matthews: Briefly: a 9 yo male with HTN had a renal artery Doppler. Aortic velocities at the level of the SMA were 235cm/s. The waveform was triphasic, the sample gate placement was correct and the angle-correction cursor was parallel to the vessels walls, Angle correction was 60 degrees. There were no color jets, just very high Doppler velocities. In the distal aorta velocities remained elevated at 185 cm/s. Renal artery velocities were "normal" (i.e. the renal artery to aortic velocity was < 1.0) . Color flow Doppler of the sub-diaphragmatic aorta did not show any areas of focally increased velocities. The child has not (yet) had a cardiac work-up. I believe that coarctation is unlikely, due to the waveform present in the sub-diaphragmatic aorta. It is unlikely that aortic valvular disease would be responsible for elevated (but non turbulent) velocities at such a remote location. He is being referred to Children's Hospital/Philadelphia for subsequent work-up. What would cause such velocities (double the adult norms) in this pediatric patient? A PubMed search turned up nothing, as did multiple searches via Google. Respectfully

Dr Matthews response:

My research of the literature produced the following:abdominal coarctation of the aorta is rare,affecting young people and often causes life threatening hypertension, that is surgically correctable.It most often occurs as a congenital defect, but may be due to healed aortitis. The narrowed segment may be quite focal, but diffuse hypoplasia of the abdominal aorta and iliac arteries may be encountered.The renal arteries are commonly involved and as s result severe hypertension is the most common presenting complaint.Involvement of the visceral arteries may lead to ischemia in their distribution. Upper extremity hypertension will be present with feeble pulses and hypotension in the legs. Surgery is required to prevent shortening of life expectancy.