You may email Dr.Matthews with your question:



Please do not hesitate to contact Dr. Matthews regarding any heart problems or symptoms, which you desire to discuss. He will gladly answer as promptly as possible!
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On this page we include some discussion threads with Dr. Matthews that may have broad appeal.
Specific names have been omitted to preserve the anonymity of the writers.

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. 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Cardiac output, however, did not appear to fall out of proportion to the diminished metabolic requirements. In addition, an echocardiographic study of patients with undernutrition secondary to a variety of chronic disease states found that the reduced cardiac output was associated with a diminished left ventricular end-diastolic diameter and mass. When adjusted for body weight, however, the cardiac index was higher than that of normal control subjects. Anorexia nervosa influences the cardiovascular system in several respects. Observations of a group of individuals with anorexia nervosa showed that the systolic ejection phase indexes of left ventricular function were normal and responded normally to exercise. The patients in this study were considered to have an adult marasmustype syndrome that did not significantly affect cardiac function; however, on two-dimensional echocardiography the left ventricular mass was found to be reduced to between one-half and two-thirds that of age- and sex-matched control subjects. This reduction was even greater when left ventricular mass was considered in relation to total body weight. Left ventricular afterload was reduced, while resting left ventricular function was normal. With the change in skeletal muscle mass the response to exercise was limited, with a lower peak oxygen consumption. In addition, there were reduced increments in heart rate and systolic blood pressure. Analysis of substrates in systemic blood showed normal glucose responses to exercise; however, free fatty acid concentrations, which doubled in control patients during exercise, showed no change in the anorexic group. The ECG in anorexia nervosa is generally unremarkable, but some patients exhibit nonspecific ST- and T-wave changes. Patientsrecovering from anorexia show improvement in heart eate andin left ventricular dimemsions.

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