E-mail received:

Husband diagnosed today with heart condition Syndrome X (X Syndrome) after undergoing an angiogram.
Where can I get information over internet on this condition. Need to know asap.Thanks

Dr Matthews response:

Syndrome X Patients with a chronic stable pattern of mixed angina, "ischemic" ST-segment depression, and/or myocardial perfusion defects during stress test, but angiographically normal coronary arteries are classified as having syndrome X. In these patients, angina also predominantly occurs on exertion, typically with a variable ischemic threshold and occasionally at rest, but very seldom at night. Although the location and radiation of pain are often indistinguishable from those of patients with flow-limiting stenosis, some distinct features raise the suspicion of syndrome X: (1) patients usually report persistence of angina for several minutes after the interruption of exertion, and many report attacks lasting over 30 mm; (2) they have a poor response to sublingual nitrates, which were also shown to worsen exercise tolerance, in sharp contrast with their established beneficial effect in patients with flow-limiting stenosis (Fig. 209-1); (3) they show a variable individual response to prophylactic long-acting nitrates, calcium antagonists, and beta blockers, possibly because of differences in the underlying causes of microvascular dysfunction; (4) they develop their typical pain (often with transient ischemic ECG changes) during dipyridamole test but without development of left ventricular contractile abnormalities; (5) they often have an enhanced response to painful stimuli, which contributes to explain the paradox of severe angina in the absence of detectable myocardial contractile dysfunction (Fig. 209-2); and (6) Holter monitoring demonstrates that some episodes of chest pain and ST-segment depression are not associated with tachycardia, and it may show episodes of transient ST-segment depression in patients with a negative exercise test, suggestive of possible episodic occurrence of microvascular constriction. The diagnosis of syndrome X is confirmed by (1) the evidence of a cardiac origin of pain because of its consistent association with transient ischemic ECG changes and/or myocardial perfusion defects during exercise test or by diagnostic ECG changes on Holter monitoring; (2) normal coronarv angiogram and (3) the exclusion of epicardial coronary spasm on the basis of distinct clinical history,absence of transient episodes of ST-segment elevation,and failure to induce coronary spasm by provocative tests. RJM

E-mail received:

Hi sorry to disturbe you, but I have just found out I have a hole in my heart, I have tried to search for it on the net but can't seem to find any medical explanation. What is the medical name? and please can you tell me about it? I'm 42yrs and only had palpations as a symptom, I now have been told I have to have surgery. Thank you for your time

Dr Matthews response:

You may be able to find the information in the Medical School Library or Hospital Library of the University of South Florida. Under the definitions on my website you will find limited information on the subjects of your interest.
Please read on my website:
http://www.rjmatthewsmd.com/Definitions/congenital_heart_disease.htm
http://www.rjmatthewsmd.com/Definitions/atrial_fibrillation.htm
Let me heard from as what defect you have!

E-mail received:

I am a 23 year old female who was born with Tetrology of Fallot. When I was 11 months old I had surgery to repair my heart. For the last 22 years my pulmonary valve has not worked and two months ago I had to have a pulmonary valve replacement and they had to repair two of three leaks in my tricuspid valve and they gave me a tricuspid ring. Since my pulmonary valve has not worked for so long my right ventricle has enlarged 49%. Since it is so enlarged it has decreased the use of my left ventricle to about 32%. My question is is it necessary for my ventricles to go back to normal? What are the odds of them going back to normal since we waited so long for surgery? If they don't go back to normal size will anything need to be done in the future? What is the long term prognosis for this sort of thing? Thanks so much for taking the time to read and answer my questions. I anxiously await your answers. Thank you,

Dr Matthews response:

Late survival is excellent, even in patients who underwent repair during the very early years of open heart surgery.Surgery can not be considered curative,since survival, even in excelllent series is slightly but significantly worse than for a matched control population.The risk factors for an adverse late outcome include older age at surgery,preopoerative congestive heart failure, a previous Potts operation,persistent right ventricular systolic hypertension, and a residual ventricular defect.Late death may be sudden,due to tachyarrhythmias or,very rarely in the current era to conduction disease.Left and right ventricular failure due to right ventricular overload or left ventricular volume overload is another important cause of late death in older patients. The late functional outcome is excellent for the mayority of patients.Most live normal lives,but the results appear to be better in those undergoing surgery at a younger age.Pulmonary valve replacement can be accomplished with low risk. Exercise performance is usually impaired when surgery is undertaken in adolescence or adulthood. The surgery you had was to treat the right ventricular failure by repairing the pulmonary valve and the tricupsid one as well.So depending on the efficacy of the operation,the right ventricular size may be reduced as it become more efficient and the tricuspid vave less regurgitating.This improvement may be reflexed in an enlargement in the left ventricular size to a point, as it pumps more blood efficiently!More surgery in the future is problematic. RJM

E-mail received:

My grandson died at the age of three weeks of an enlarged heart could you send me an explanation of this and also if it could have been detectedand helped.

Dr Matthews response:

What did the autopsy report say? Did the baby have a congenital heart defect? These are usually detected at birth, but a significant number escape until later in life depending on their severity!Is there a family history of such? So before one can discuss diagnosis etc the actual findings need to be known!

We need a national screening law to screen new borns at birth for all the recognizable diseases , which we can treat and save lives! I am watching a program now on TV with Senator Dodd of Conn. re newborn screening for these diseases.You could write to him to give support for manditory testing! Try to get the name of what the baby died! RJM

E-mail received:

Dear Dr. Matthews, My name is Kali and I'm 14. I'm writing to you because I have a question. For a while now, I have been having chest pain. When I get it, I also get light headed, out of breath, and my right arm and sometimes my neck almost always hurt. Also, my cheeks get red and I get really sweaty. This happens sporadically, not at particularly stressful times etc. In addition to that, most of these symptoms also occur when I'm running or exercising and at times when I'm lifting really heavy stuff (like my 100 pound backpack). When all that happens, it usually lasts anywhere from 15 minutes to an hour. It helps when I sit down... but not much. I've looked at several resources on the internet, and I am aware that most chest pain in children and teens is normal/insignificant, especially in teen girls, though, I couldn't find anything that incorporated all my symptoms, accept adult MI symptoms... :-/ Do you have any idea of what happens to me could be and the level of its severity? Thanks! :)

Dr Matthews response:

You should also get a 24 hour ECG Holter test, as you may be having a cardiac arrrhythmia!
Ask your physician to get an echocardiogrm and a stress EGG test!
RJM

E-mail received:

Dear Sir, Generally persons fitted with pacemakers are advised to keep away from electronic gadgets including cell phones to avoid any radiofrequenct interference between the signals from the gadgets and the pacemaker electronics. A question has been raised in our hospital whether a person with a pacemaker can undergo phaco surgery for the removal of cataract. Since the phaco energy is acoustic energy I think it should have no effect on the pacemaker electronics. Please let me know whether I am correct. Thanks.

Dr Matthews response:

Electromagnetic Interference of Pacemaker Function In general, electromagnetic interference (EMI) can originate from a variety of sources that have the potential to affect pacemaker function adversely. In Table 8 are listed some of the more common sources of EMI with potential pacemaker effects. TABLE 8 Sources of Electromagnetic Interference and Potential Effects Among other things discussed in this table as a cause of interference with pacemakers is extracorporeal shock-wave lithrotripsy! Unipolar pacemakers are usually more susceptible to EMI interference than are bipolar pacemakers because the sensing circuit encompasses a larger area compared with bipolar sensing. Factors that affect EMI interference have to do with the source of the interference and the proximity to the pacemaker generator. Many of these sources are located in a hospital environment or specialized places such as construction sites. Magnetic resonance imaging scans are contraindicated in patients with pacemakers, although there are case reports of patients with pacers undergoing MRI scans without adverse events. Sources of EMI at home and the office usually do not pose a problem for patients. There is concern, however, that electronic article surveillance devices, found commonly in retail establishments, can interfere with pacemaker function, if patients linger by these devices. The effects of EMI vary according t o its source and the type of pacemaker. Inhibition of pacing output can potentially be life threatening for patients who are pacemaker dependent. If the EMI is interpreted as atrial events by the pacemaker, then inappropriate ventricular pacing may occur in patients with DDD pacemakers, since these pacemakers attempt to track these events, which are interpreted as atnal. EMI often causes electrical noise that causes the pacemaker to function in a noise reversion mode. The actual function of this mode differs among the different pacemakers, but this mode involves switching to an asynchronous pacing mode. After elimination of this interference, pacers generally revert to the previously programmed mode; however, it is possible for EMI to cause pacemakers to revert to a backup pacing mode. Backup pacing in some models is unipolar VVI pacing at a preset rate. Occasionally, EMI causes permanent damage to the pulse generator. Therapeutic radiation can damage the complementary metal oxide semiconductors (CMOS) that are part of most modern pacemakers. Generally, doses in excess of 5000 rad, but as little as 1000 rad, may induce pacemaker circuitry damage, which in turn can cause pacemaker failure or even induce a runaway pacemaker. If the pacemaker cannot be shielded from the field of radiation, then consideration should be given to reimplanting the pacemaker at a distant site. In studies examining interactions between pacemakers and cellular telephones, it was noted that digital telephones may cause intermittent pacemaker dysfunction. These adverse effects observed included pacemaker inhibition, inappropriate ventricular tracking (in VDD or DDD pacemakers), or resetting the pacemaker to a backup asynchronous mode. Factors associated with interference include unipolar pacing systems, digital cellular phones, increased output by the cellular phone, and close proximity of the cellular phone to the pacer. Because of the diversity of cellular phones and pacemakers that have different shielding capabilities against electromagnetic interference, it is difficult to draw firm conclusions on the use of digital cellular telephones.159 No consistent problems have been detected with analog telephones. It is advisable that patients use cellular telephones that are analog or to keep digital cellular (with power outputs greater than 3 W) phones 20cm away from their pacemaker generator.

So if lithotripsy uses sound waves ,which can interfer with the pacemaker,then one has to wonder about the use of the phaco surgery with the acoustic energy!I really do not know the answer, but you could write or call Medtronics about their advice! RJM

E-mail received:

Some brief history first. I have a slow resting heart rate of about 35-45. It responds approiately with exercise or any type of activity. I'm 23 years old. I run 15 miles a week, and do weights 3 times a week. I had an echo, it was normal, and a holter two years ago showed an average rate of 60, I had one last month showed an average rate of 47. It showed some PAC's and PVC's, but not enough to be clinically significant. My EP I believe calls my condition sick sinus syndrome. He tells me that I may need a pacemaker someday. He says it could be 20, 30, 50 years or never. The problem is I worry it could be tommorow, a week, 3 years. I also have panic/anxiety disorder. My questions are. 1. Is it possible this is just normal for me and I do not have anything wrong with me heart. My EP seems to play down the my exercise as a cause since I'm not an elite trained athlete. What do you think. 2. My holter showed my slowest rate at 20, during sleep, with sinus pauses up to 3.1 seconds, during sleep, but mostly during sleep it was in the low 30's so the 20 could have been an anamoly. Mostly my rate seemed to be in the low 30's. This worries me that my heart will stop working and I will die in my sleep that I'm at increased risk for dying in my sleep. Could I have sleep apnea. My holter two years ago showed the slowest beat at 30. I did not remember seeing anything about pauses, but this recent one showed over 1000, varying from 2.1 secs to 3.1 My ep said it was normal. What do you think. 3. I also saw on my holter that my average was 47 bpm, where my holter 2 years was 60. I worry that my condition has deterioated, or could it be related to my increased fitness since then, and I have lost 20lbs since then. What is your opininon. Is it even concieveable that it has deterioated that quickly. 4. Based on all this what would you say is the soonest I may need a pacemaker, 1 year, 5, 10, 30, or never. 5. What worries me the most is the change in the two holters. Would you say it is not so likely, maybe, possibly or highly likely it is just my hearts reaction to my exercise. 6. My other big worry is I do feel lightheaded and dizzy, but have never fainted. I do not know if it is related to my heart or anxiety disorder. They are symptons of both. So how does someone with panic disorder distinguish. Sometimes I feel dizzy so at 38bpm and at 65bpm. Thanks very much from a very scared patient.

Dr Matthews response:

It is doubtful that you will need a pacemaker any time soon ,and maybe never!The heart rate is probably related to your physical conditioning.Your other symptoms are probably related to your anxieties,which be addressed to your mental health care giver! The below may help you: Bradycardia is a condition of the heart in which the pulse rate (heart beat) falls to a level, which causes the patient to have symptoms of fainting as well as easy fatigue, dizziness, etc. see definition Bradycardia

E-mail received:

I wanted to thank you for your response. This is a wonderful service you provide and you are a wonderful person to offer it. One last point I wanted to bring up my doctor says what makes me different than just having a resting pulse of 40, is that within a second my pulse can go from 80 to 45, this is why he calls it sick sinus. What I do not understand is when I exercise it takes my heart rate a couple minutes to go from 160 to 90, and it slowly decreases from there. I guess when I stand up and from my desk to the bathroom or what not my heart rate gets up to 75, then within a second goes back down to 40's. Just wanted to see if this effected your answer, and any additional thoughts on what I wrote above my help to ease my mind. I also wonder how many people have this and do not know it, I went to 1 family doc and 3 cardiologist, and the third one said the only reason it was caught was I pushed him to do more tests. He says we would have been better off if I never knew. Thanks again.

Dr Matthews response:

"What I do not understand is when I exercise it takes my heart rate a couple minutes to go from 160 to 90, and it slowly decreases from there": the preceding sounds normal to me.That is, the rise in pulse seems normal with exercise, and if it slowly decreases while you are exercising ,it may mean that your body has trained itself to need no more oxygen than what is provided at that heart rate!And if it goes down after exercise ,that is normal! "what makes me different than just having a resting pulse of 40, is that within a second my pulse can go from 80 to 45, this is why he calls it sick sinus".Well,the same thing can happen in well trained athletes and during sleep and in otherwise normal people with some degree of sinus arrhythmia. The range of rates defining normal sinus rhythm is between 60 and 100 impulses a minute.The rhythm is usually regular, but a rhythmic variation exceeding 0.12s between the longest and the shortest cycles in a sequence on a resting ECG defines sinus arrhythmia.This normal variant is most common in children and decreases with advancing age(it can occur in adults and elderly patients).It usually has a phasic pattern,in which the cycle lengths shorten with inspiration and lengthen with expiration.If the cycle is unrelated to the respiratory cycle, it referred to as nonphasic. Sinus bradycardia ranges from a benign asymptomatic physiologic adjustment in heart rate to a symptomatic expression of sinus node dysfunction.The asymptomatic forms are most often benign and related to physiologic(e.g.,training effect) or pathologic(e.g.,Inferior wall infarction) excesses in vagal nerve tone.Drugs that can cause sinus node depression include bete blockers,calcium channel blockers,amiodarone,lithuium,cimetidine and adenosine.Radiographic contrast materials can cause it in sensitive people. Sick-sinus syndrome is a general term used to indicate abnormalities of cardiac impulse formation and intraatrial and AV conduction that may manifested by various combinations of brady-and tachyarrhythmias.I do not consider a pulse rate of 85/m as a tachycardia and hence I do not feel you have met the definition of sick sinus syndrome. I do not believe you have had tachyarrhythmias(unprovoked rates over 100-200+/m)! Occasionally,electrophysiologic testing is done to made the right decision! It is important to understand that I am not advising you, as I have not seen your records nor examined you! RJM

E-mail received:

Dr. Matthews, I am a 29 year old female and previously considered myself to be in good health. I am 5'4" tall, weigh 112 lbs, work out 4 times a week, and have never smoked. A recent thyroid panel came back normal. My recent work physical revealed that my triglycerides are 54, and my cholesterol is 167 with HDL being 60. My allergist had asked me to participate in a clinical trial and part of the trial required an EKG to be run. It came back irregular of "clinical significance." I went to my primary care physician who ran another one. It showed that my heart rate is 59BPM and I have "QRS(T) contour abnormality consistent with anteroseptal myocardial damage." I have no chest pain or shortness of breath, but have been referred to a cardiologist. In the mean time, I'm kind of scared. What does this mean? THank you,

Dr Matthews response:

Please send me an attachment of the ECG! The findings may be a normal variant!You may need an ECG nuclear stress test and an echocardiogram!

E-mail received:

Thank you for your response....here is the first EKG. It is the only one for which I have a soft copy. The second one essentially determined the same thing only the diagnosis read "anteroseptal myocardial damage." (a small semantic) I really hope it is a normal variant because I don't know how I could possibly be more health conscious and all my other factors...weight, cholesterol, exercise, triglycerides are great. Thank you

Dr Matthews response:

I was able to see a part of the ECG,which was on its side rather than straight up,but turning my head to the left allowed me to read the leads available,which included AVR,AVL,AVF,VI,V2 and V3.Leads V1 and V2 show an abnormal virtual QS wave ,and V3 shows poor 'r'progression.There is T wave inversion in Leads V1 and V2 ,but the T is normally upright in V3. Leads 1, 2, 3, V4, V5, and V6 are missing. The findings are abnormal and suggest a possible old anteroseptal wall myocardial injury. So it is advisable to have an ECHOCARDIOGRAM and a STRESS ECG NUCLEAR TEST to determine the significance of these findings. It is possible that the findings represent a congenital or some other condition rather than coronary artery disease.Any history of trauma to your chest?Any other health problems? Please keep me informed!

E-mail received:

Thank you for reading the ECG! Unfortunately, you seem to agree with everyone else that there is some kind of problem. I would doubt very seriously that I have heart disease because of my low cholesterol, low triglycerides, highly restrictive diet (self imposed), and aggressive work out regimen. To my knowledge, I have never suffered any kind of trauma to the chest either. I've never been in a serious car accident or anything like that. This leaves me with the only likely scenario being some kind of congenital defect. I am hopeful that it is not serious in that I have never had any problems and stumbled upon this by accident. My resting heart rate averages between 55-58 bps so I assume, in spite of this damage, it at least beats efficiently. The good news is that I was able to take a cancellation appt with the cardiologist and get to go this Friday rather than Oct 25. I've gone 29 years without ever knowing I had this, but now I'm suddenly desperate to get it resolved. Thank you so much for all your help! This has been kind of scary and unsettling and it's nice to know there are people in the world who still reach out to strangers.

Dr Matthews response:

My pleasure!I feel that after the investigation you feel a lot better! Keep me informed! RJM

E-mail received:

I recently has an echocardiagram and the results were "mild hypertension" with an enter-artrial septal aneurysm with out shunting. I have no idea what the severity is of this condition. I do take Procardia xl, bid and have been stable with my PPH for 7 years- by measure of a heart cath. I am scheduling an appt. with a cardiac doctor but would appreciate all the info you can provide. Thank you for your time and quick response.

Dr Matthews response:

Can you send me a copy of your echocardiogram report.Is your hypertension in the pulmonary arteries or is it systemic.If it is in the pulmonary arteries,what is the cause,primary or secondary(i.e.pulmonary embolism)? What is meant by PPH.Procardia xl is usually used to treat systemic hypertension!I was not aware that it helps pulmonary hypertension.There are special medicines in research for treatment of pulmonary hypertension.Why did you have to have a heart catheterization? Do you have congenital heart disease?RJM

E-mail received:

I was diagnosed with primary pulmonary hypertension 7 yrs ago. I underwent a heart cath to get a more axact "pressure". It was 3 times higher than normal- I started the procardiaxl and the next year my pulmonary pressures were stable on the med. Since I have been dx- the doctor uses the echo to keep an eye on the pressures- even though it isn't as exact as a cath. This recent echo showed what I wrote you about. Any suggestions?

Dr Matthews response:

Yes !They have the new drug ,bosentan, at the University of San Diego Medical School Hospital and Scripps Clinic .I would suggest you contact them for this drug!I'll try to get the Doctor's name and phone number. Please read the below: TREATMENT OF PRIMARY PULMONARY HYPERTENSION - THE NEXT GENERATION

I was able to contact a lady under Dr.Richard N.Channick ,MD's care at the University of San Diego Medical School Hospital,who is using a new drug called "tracleer" for your problem( his phone number is 1- 858-657-7150)

E-mail received: OK

Hello: Would you tell me what can be done to prevent further thickening of the heart walls, and is this normal as one gets older? I had an echocardiogram, and I was told that everything looked okay; however, there is a thickening of the heart walls. Thank you,

Dr Matthews response:

Can you send me the report of the echocardiogram as an attachment to the e-mail? It would help with the interprtation. How old are you?What is your weight and blood pressure?Do you have high blood pressure?What are your cholesterol and blood sugar? Thickening of the walls of the heart could mean that high blood pressure has caused it.Of course, the treatment is to lower the blood pressure with medication and weight loss,and reduction of salt in the diet.This is assuming that there is no heart valve problem or heart muscle disease. RJM

E-mail received:

On my aunt's CT report it states that she had significant calcification in her coronary artery. How can they find this out when she was getting a scan of her lungs? What is coronary artery calcification? What happens if you have it?

Dr Matthews response:

During the scan the heart is included!The calcification may indicate signicant coronary artery atheroscleroosis, which can lead to a heart attack.Itis related to the level of the blood cholessterol.The signifidance can be evaluated with a stress ECG nuclear test,which can be scheduled by your aunt's doctor.

E-mail received:

I have a 88 year old mother who is in very good health except for high blood pressure. she is under medication and lately she complains of tingling in her arms. she is really a young 88. cuts her own lawn-cooks and cleans her own house. I take care of her doctors and grocery shopping. she travels to Atlanta and Kentucky to visit my brothers. she gets tired after a visit but still enjoys it. sometimes it is by plane and other times by auto. she just returned from a 3 week stay in Kentucky and it complaining about her arms feeling weak and tingling. she refuses any tests by doctors and continues to blame the medicine. we have had her on many different meds for her blood pressure and she seems to get every side effect that she reads about!!!! this last medicine seems to make her feel much better and she is enthusiastic about life and energetic. yet she still continues to blame the medicine. HELP!!!!!!!!

Dr Matthews response:

Possibly the tingling is from a peripheral problem in the elbows due to arthritis pinching a nerve,or more centrally from arthitis in the neck cervical spine involving nerve impingement bilaterally.Transient cerebral ischemia seems unlikely.Finally it might represent angina pectoris due to coronary atherosclerosis.Of course,an ECG,x'rays of the cervical spine and elbows,EMG and nerve conduction of the arm nerves would be needed to diagnose the cause of the symptoms. The question is getting your Mother to agree to the tests! RJM

E-mail received:

I have been diagnoised with afixed anterosepatal defect. Will it require surgery?

Dr Matthews response:

I suspect the defect is due to a prior myocrdial infarction.I assume the doctors will want to do an angiogram to see which artey is blocked and then decide on the best treatment for you either by- pass surgery or to do angioplasty and insert a stent.Have you had chest pain high cholesterol,strong family history of heart attacks or whAt? Or do you have a congenital defect and if so, how severe is it?How old are you?DR.Matthews

E-mail received:

the doctor told me it was somehting growing from the wall of my heart and he thinks it might be starting to shut off the flow of the blood.what is a congenital defect this problem was not there 3 yrs ago when i had a stress test done please help me to understand this problem

E-mail received:

My daughter is having her third heart surgery. First @ 7yr second @ 16 and now at 33, for "redo" of her right ventricular outflow tract. She is under the care of Dr. Hillel Laks at UCLA. I am very confident with his reputation and ability, however how long do surgeries like this usually take. Approximately? Thank You A concerned Mother

Dr Matthews response:

You are right! Dr.Laks is a famous,fabulous cardiac surgeon!I do not know the time for completion of the operation, being on the medical side of management,but it could a morning or at least several hours!I wish the very best for your daughter! Dr.Matthews

E-mail received:

dr matthews i dont know if this will make any since to you but im going to ask.since my surgury on sept 17 i felt good about 3 or 4 days. since the surgury then after that i started having the same pain but there worst now than before my surgury i had angioplasty 3 stents put in and one was unplugged.my left arm gets numb and real sharp pain in my left side of my chest. and the worst pain seems like its in my left shoulder,any way what i dont understand during the day i fill great no pains at all its when it gets dark when im ready for bed usually around 8 to 9 pm the pains start and its every night it will do it 3 or 4 times last maybe 30 seconds and go away.could you maybe explain what might be happening to me for it to be almost like clock work to start having the pains every night.thank you very much for your help and for answering my previous questions.

Dr Matthews response:

You may experiencing pain due another cause such as musculoskeletal origin or like a pinched nerve in your neck due to herniated cervcal spine disc.So you need to see your physician to have to diagnose him the condition, which appears related to your activity and position in the bed at night.X'rays of your chest, cervical spine and left shoulder and an orthopedic and/or neurology consult may be in order.RJM

E-mail received:

sir I am vishnu diagnosid for mitral valve prolapse?How does it affect my day to day life and future life?Do I need to take any precaustion from now on...?At present I have following symptoms fatigue chest pain dizziness depression thank u

Dr Matthews response:

The majority of patients with mitral valve prolapse(MVP) are asymptomatic and lack a high risk profile.These patients with mild or no symptoms and findings of milder forms of prolapse should be reassured of a benign prognosis.A normal life-style and regular exercise is encouraged. Itis recommended that antibiotic prophylaxis for the prevention of infective endocarditis whil undergoing procedures associated with bacteremia for most patients in whom the diagnosis is definite. Patients with MVP and palpitations associated with sinus tachycardia or mild tachyarrhythmia and those with chest pain,anxiety,or fatigue often respond to therapy with beta blockers.In many cases,however,the cessation of catecholamines stimulants such as caffeine,alcohol, cigarettes,and certain drugs may be sufficient to control symptoms. Orthostatic symptoms(dizziness,fainting) are best treated with volume expansion preferably by liberalizing fluid and salt intake.Mineralocorticoid therapy may be needed in severe cases,and wearing support stockings may be beneficial. In those with complex arrhythmias, specific therapy should be guided by monitoring techniques,including electrophysiology testing when indicated. Daily aspirin therapy is recommended for MVP patients wit documented focal neurologic deficits,avoiding cigarette smoking and oral cotraceptives.Use of anticoagulants may be indicated in those who suffer a stroke. Restriction from competitive sorts is recommended when moderate heart enlargement,left ventricular dysfunction,uncontrolled arrhythmias, unexplained syncope ,prolonged QT interval alone or in combination occur. There is a familial occurrence.Ther is no contraindication to pregnancy based on the diagnosis of MVP alone. Patients with severe mitral regurgitation with symptoms and/impaired left ventriclar function require cardic catheterization and evaluation for mitral valve surgery.,including repair or replacement,with a low operative mortality and excellent short term results and lessemboli and infection. Asymptomatic patients with no significant mitral regurgitation can be evaluate every 2-3 years. High risk patients including those with severe regurgitation should be followed more frequently, even if no symptoms are present.

E-mail received:

hi Robert firstly Thank u for ur kind suggestions and reply.I was proscibed Inderal 10mg and asked me to take for the rest of my life.What if I don't take them?Can u please advice me. Thank U in advance

Dr Matthews response:

Inderal, a beta blocker,is to help prevent cardiac arrhythmias.So I would do exactly what the asked to do!RJM

E-mail received:

Dear Dr. What does it mean from my TEE report rt. atrium chiari IAS-IVS of small patent foramen ovale? Is this in regards to a hole that they may have found? Thank you

Dr Matthews response:

Yes, it appears that is the case.This defect classically involves the region of the fossa ovalis and is the most common type (70%).Atrial tissue separates the inferior edge of the defect from the atrioventricular valves(mitral and tricuspid ones).Perhaps you could send me the entire report for better understanding; also what are your symptoms and how did you come to have the study? How old are you,etc? Of course,Your cardiologist can and should explain it all to you! RJM

E-mail received:

After reading your message back to me I still am not quite surrre what it all means. I am 58 years old. I recently had brain surgery in May to clip two aneurysms. Can you explain a little more for a better understaning what the defect really means to my health? Thank you

Dr Matthews response:

Sir,You should speak to your cardiologist regarding what to expect from this defect,for I have not examined you and can not advise.I can only give general information. How did you come to have an echocardiogram?Were you having fatigue and shortness of breath?Did your doctor heard a heart murmur?Did your Doctor think you had had a blood clot go from your heart to your brain through the heart defect?What did your chest X'ray and electrocardiogram show?Have you had a heart catheterization? In significant atrial septal defects,heart failure may occur more commonly in adults,ages 40-50+ years,usually with the onset of arrhythmias(irregular heart beats).Some of these patients develop high blood pressure in the arteries in the lungs,blood clots in the lungs as well in the brain and elsewhere,brain abscess, and infection. Significant defects warrent consideration of surgical closure.RJM

E-mail received:

I am in the Cardiovascular Technology program at Grossmont College. I am writing a paper on the Echocardiographic indications for Aortic valve replacement in aquired AI. I have found some material on the indications but I was wondering if you could give me a little more information on this subject. Any information or references that you may have would be deeply appreciated. Thank you for your time and help. Sincerely

Dr Matthews response:

Serial echo's indexes of systolic and diastolic function during exercise and at rest aid in timing an aortic valve replacement.Asymptomatic patients who have normal dimensions at exercise and at restr are not considered for operation, but surgery shoul be considered if they have signicantly decreased left ventricular function on streescintigraphy or echocardiography or develop hypotension orarrhythmia on exercise testing.Patients who have an end-systolic left vevtricular diameter greater than 5.5cms. by echocardiogram,have worse longevity and left ventricular function than patients operated upon with smaller ventricles.This single measurement must,however, be interpreted in light of all tests of left ventricular function and should not exclude any patient from operative consideration.Reference:Bonow,RO and others;The timing of operation for chronic aortic regurgitation.Am.J.Cardiology,1982;50:325-36

E-mail received:

I have run into this term only once dictated by a cardiologist and cannot document. Could you perhaps tell me what LAD "paratree" is and if this is the correct way to spell it. I would be most grateful and would help me in my research. Thanks

Dr Matthews response:

LAD could refer to the left anterior descending coronary artery and the word paratree,which I have never seen before,but be referring to the variou diagonal and septal branches, which come off the LAD like limbs off a tree.RJM.

E-mail received:

Have been having queasy, lightheaded, extreem weak spells with my LV diastolic failure problem. They last an hour or so, and I have to lay down with these spells. BP is stable with these, but heart beats go to 120-150 per minute. Is this symptom related to chf or could it be something else. I hesitate to call the busy cardiologist because he will say come in and my GP just retired, so I'll be glad to get your thoughts. Thanks and God Bless

Dr Matthews response:

What is the cause of the lv diastolic failure?How old are you?What tests have you had for this problem?What is your cholesterol etc.Have you had a 24hour Holter ECG test and what did it show?If you did not have the Holter test, then you should have it, and an ECG echocardiographic stress test to try to discover the cause of your symptoms!Who verified that your pulse rate is 120-150/Min. with these episodes, the nurse ,layman or professional help?Who took your Blood pressure? Remember that only your doctor can diagnose and treat you.So call and go see him.He is the authority on you!You have the insurance,so go and see him ,even if you do not have insurance!He is not so busy ,that he can not see you! You may be having an arrhythmia causing your symptoms,but your doctor must verify it.RJM

E-mail received:

Thank you Dr. Matthews for responding so quickly, I have 15 year history of 160/90 bp and high cholosterol of 200-244 most of the time, now better controled by Lipitor. I've had angiogram, (clear arteries) and echocardiogram, thallium testing, blah blah blah. Never holter-monitor. All tests reveal CHF. I have a home bp monitor/pulse readout. The queasy/uneasy spells are perplexing as they seem to come on sometimes after having my arms up high, cleaning, curling hair, etc. Also during time of severe pain from osteoarthritis/fibromyalgia and at times of emotional stress. I am 65 yr/female who used to walk 5 miles per day until 2-3 yrs ago when symptoms/slight to moderate, increasing gradually. The first episode happened on the tredmill at 3 mil per hr with a 2% incline. ecg showed sinus brachycardia, was then sent to cardiologist for eval. who then ordered cath. I am on atenolol, lasix,potassium and nitro spray for chest pressure

Dr Matthews response:

Thank you for the information!When did you have the angiogram?Is there a family history of coronary artery disease?Are you overweight? Your cholesterol should be under 200! What is your LDL and HDL? Did the treadmill test show ischemia?What did the thallium test show? Still think you should ask your cardiologist about getting a Holter test to discover the arrhythmia causing your symptoms.RJm

E-mail received:

what is "inr" - related to prescription of coumadin.

Dr Matthews response:

The inr relates to the time it takes the blood to coagulate while the patient is on coumadin.RJM