Our email:



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!
Page 1 | 2 | 3 | 4 | 5
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:

Dear Dr. Matthews: My name is Jacqueline. I had an amplatzer device of >>>trans cath closure Dec. 17 2002. I had a hole in my atrial septal >>>defect congenital hole in my heart from birth. I have shortness of >>>breath and am weaker on my right side with numbing feeling on my right >>>hand and tingling on my righthand. I had a transient ischemic attack >>>September 2002. I was unable to speak correctly. I had abornal eeg. >>>with no conclusive report of seizures but it may indicated with this >>>last report. I am waiting results. I had chest pain yesterday with >>>right side weakness. The pain was located on upper right above chest. >>>I had a cat scan that indicated no emoboli. I think I may have an >>>infection or had another T.I.A. What do you suggest. I had been >>>exercising all along and otherwise healthy. My cat scan showed >>>nonspecific enlarged lymph nodes behind the breast bone. Thank you for >>>your help.

Dr Matthews response:

>How old are you?Transient cerebral ischemic attacks usually occur in >>older patients with arteriosclerosis in their carotid or cerebral >>arteries,which are threatening to close off their lumens.Are you having >>any visual symptoms such as transient blindness.Are you on an >>anticoagulant!Have you spoken to your cardiologist re these residual >>symptoms? >> >>I suppose that very small emboli could cause similar symptoms,but you >>have had the amplatzer device implanted 2mos. ago,but it may not be >>completely closed,although most of them close completely within a few >>months of the procedure! >> >> Is the right upper chest pain aggravated by breathing(inspiration) and >>accompanied by coughing up blood and the shortness of breath? Did you >>have the shortness of breath before the procedure,due to right heart >>failure from lung emboli? You could be having emboli to the right lung >>even though the occluder has closed the defect,since the blood clots >>can still gothe the lungs through the right side of your heart! >> >>You wrote that a CT show no embolus! ? Was the CT of your lungs(I guess >>it was because you did mention your breast bone) or of your brain! Have >>you had a CT of the brain,and if not perhaps a MRI would be helpful! >>Also, if you are continuing to have chest pain,there may be a need to >>have a pulmonary angiogram! >> >>I look forward to your answers! >> >>RJM

E-mail received:

Hello again Dr. Imy right eye vision is a little worse than the right. I > noticed. I don't have any transient blindness. I am not numb just notice > that my upper chest is not right. I have more pain when I breathe in. Not > much coughing but I do spitt up some more yellow like phleghm in morning > when I awake. I've contact UM they don't think it is heart related. Don't > know what to do. I am on baby aspirin 1x's day. When I exert myself just > around the house I breathee harder. I don't have a significant fever. I > always have a lower temp when I am not well. Thanks again. Jackie They did > a cartroid artercy check before I had my device. It was fine. Aslo, Dr. > they never told me they saw an emboli. They just presumed it was a TIA from > symptoms. I guess in my mind, a transient means it is passing not clotted > somewhere. Thanks for your help. I am in college and trying to get through > healthy and I work 40 hours.

Good Morning Dr. Matthews: It all started in September 2002. I woke up > early as I always do and I always talk to my friend Patty. I was talking to > her at 6a.m. fine for a few minutes then all of a sudden I couldn't speak > the words I wanted to. I knew what I wanted to say in my mind but couldn't > come out correctly. For example I wanted to say dog and thought dog and > said cat. My speech was slurred for a few minutes. I was very frustrated. > This lasted for about 6 to 7 minutes. This was the only symptom. A MRI and > eeg showed no bleed and they just predisposed it to a TIA. I don't know how > else to know if it actually was. I had two abnormal eeg they said I may > have seizures. I should get the result of the third eeg today by Dr. Broder > out of Genesys. Dr. Harris did a TTE about October 2002 and found I had a > hole in my heart about 1/2 inch. with left to right shunt. I had > shorthness of breath from September to December 17 2002 when I had a > transcath closure of my Atrial septal defect with amplatzer. They said it > was successful. I have been working out and specifically with free weights > which I haven't done for awhile, but I've always exercised with walking and > I don't have don't have high blood pressure or cholesteral problems. I'm 47 > years old and think I'm in pretty good shape except for this past year. I > was in the hospital Jan 2002 with drug induced hepatitis and had congestive > heart failure do to increased liver enzyme. I was off work for 2 months. I > was really weak and jaundice. The drug I had taken was mellaril for 12 > years. They said this was the culprit. I am on paxil and am not jaundice > now. I thought may have had pulled amuscle on my upper right above my chest > but the pain was like stabbing almost like labor. It scared me. They put > me on torditol in the hosptial and did a cat scan of my lungs and chest. > They said I had few nonspecific lymph nodes that were enlarged of > nonspecific nature. They weren't worried. I do hope they know what they > are talking about. My red and white blood coutn is normal range but my > lymph differential absolute lymphs is .9 and my lymph % is 16 low. My rdw > is 16.8 high I don't know what this means. Yes , when I breathe in my > chest on the opposite side of my heart hurts but not as bad, but it is > strange to think a pulled muscle would last this long. I had a cat scan of > my brain and it showed no bleed. They did blood cultures and I should know > hopefully today. or tomorrow. I feel weak and not up to par but my period > is due and this may precipitate feeling blah. They said there was no proof > of an emboli in my lungs. I have slight tricuspid and mitral valve regurg. > The hole in my heart was from birth. My brother said I had rheumatic fever > as a child as was very ill. Thank you Dr. for your input. I look forward > to talking to you. Sincerely, Jacqueline. Also, they put me on lenaquin. > dinal

Dr Matthews response:

Sounds like you have bronchitis,which the levaquin should help.If you do not feel better soon,you should a lung specialist (pulmonologist) or an internist to investigate further.Have you had an ordinary recent chest X'ray? Do you wheeze when you expire? Could you have asthma? RJM

You seem too young to have transient cerebral ischemic attacks,unless we call the emboli to the brain "TIA's",which is not correct strictly speaking.I can understand why they are investigating possible seizures from epilepsy as a cause ,but the seizures may have been due to cerebral emboli(this keeps things simple).I presume the levaquin is for suspected infection from the procedure of putting in the Amplatzer device?But your white count was normal, and you awaiting the results of the blood cultures. I find it interesting that you had congestive heart failure in January 2002.I suspect that it was due to the atrial septal defect with right heart failure rather than the hepatitis.How did they treat your heart failure? Of course, you should do well cardiac-wise as soon as this issue of infection and the spells of "TIA'S" is clarified! Look forward to hearing from you! RJM

 

 

 

E-mail received:

Tha

Dr Matthews response:

Your

E-mail received:

Doctor M

Dr Matthews response:

No,but I am

E-mail received:

Thank Y

Dr Matthews response:

You are !

E-mail received:

I had a pacemaker put in 5 1/2 weeks ago, and would like to know what > happens when you get a staph infection in the pacemaker pocket. The > site started swelling 1 week after i had it put in and i was put on > antibiotics and told it was a fluid build up. 4 days later the wound > split open and the fluid came out. The wound didn't heal after this, so > the doctor did a swab and found a staph infection. I was put on more > antibiotics and it still looks the same. I have to go back to the > doctor in 4 days and he will decide what to do. I may have to have it > removed. > I would like to know if they remove the device will they have to move > the leads as well. The doctor has also said it will no longer be minor > surgery it will now be major surgery. I am unsure why. Wouldn't it > just be the same except it is put on the other side. > Also what are the symptoms of a staph infection, as yet i have none. I > feel fine, except for a red wound and a little swelling and it is a bit > sore to touch, i am not sick at all. > I would appreciate your responce as i am getting a little scared about > the whole thing. > Thanks.

Dr Matthews response:

If the pacemaker is infected,removal of the leads and generator is usually required. The symptoms of the infection,if localized,can be like what you are experiencing now with local pain.But if the infection spreads into the blood stream you are in big trouble with chills ,fever,fatigue, weakness,and other constitutional issues! If the leads are infected(0.2-7% of patients),as in infective endocarditis,cure requires the removal of the pacemaker generator and the leads, and treatment with antibiotics.

E-mail received:

Thank you for your quick responce Dr Matthews. I am probably worring about nothing. Hopefully it will all be ok when i see the doctor on Wednesday. Thanks again.

E-mail received:

During the night I am awaken with numbness in the left arm and muscles > jerking so hard that it causes the arm to jump. > > Is this somethine to cause alarm? > > Thanks,

Dr Matthews response:

Can you go into this in more detail? What muscles are jerking? All over the body or just in the left arm?If it is only the left arm,how long does it last? How long have you had this symptom? Has it grown worse?How old are you? Does it occur with fatgue or what? Do you have other medical problems!Do you have seizures? Any head injuries? Are you under a lot of stress? How do you sleep in bed posture-wise? RJM

E-mail received:

Greetings, > My mother as operated just six days ago. > She underwent quintuple by-pass surgery. Dr. Bracamontes performed the > operation here in McAllen, TX. > She seems to be doing alright as of now. My question, however is based on > the fact that the doctor informed us that her left lung has a bit of fluid. > How frequent is this? and is this dangerous? Can it lead to other > complications? > I understand that if it does not go away, it will be drained, but once done > is there a chance that the fluid can return? > I am also concerned about how rapid they are moving her around. She seems > so fragile, now 70 years old. Is there a site I can visit that can direct > me to caring for her properly without hurting her? > Please inform.

Dr Matthews response:

It is common to have fluid in the left pleural space after these surgeries ,as there is more pressure put on the left lung at surgery leading to lung collapse.There is fluid drainage into the space as well even after the chest tubes are removed,the fluid is usually not considered dangerous!It usually does not reoccur!Ordinarily there are no further complications.Yes,the fluid can be drained if there is a problem,which does not happen too often!It usually does not return! Ambulation soon after surgery is good ,improving the patient earlier in terms of deeper breathing,pulse, blood pressure, heart rate, preventing blood clots in the legs,which cause emboli to the lungs.It helps the patient to take deep breaths and helps to prevent lung collapse.Staying in bed is dangerous! Early ambulation limits the detrimental effects of deconditioning.Patients should feed themselves,perform personal care,use a commode at bedside,and sit in a bedside chair.We believe that fast tracking is important in patient care!Patients should perform leg and arm exercises and increase flexibility and joint mobility.Incentive spirometry is important.Walking is very important progressively! Age 70 is still young and I'm certain your Mother does not want to be referred too as old!

E-mail received:

Dr. Matthews I am a 51 year old female. I just had an arteriogram performed. > It was discovered that I have an A-V fistula and would be interested in any > information you may have. I understand this is pretty rare. I would like to > have the symptoms, etc. I have talked with a surgeon who is bringing this > before his peers to discuss. II do have an irregular heart beat and a leaky > Mitral valve. Any informatiion would be greatly appreciated. Thank you.

Dr Matthews response:

But where is the arterio- venous fistula and how did you get it? Traumatic or congenital?Why did you have an arteriogram performed? RJM

I am sending you two examples of arteriovenous fistulae(abnormal communications)involving the coronary arteries,the pulmonary artery or right ventricle,both venous structures!But the inferior vena cava,pulmonary veins or other vascular strictures(mediastinal vessels,coronary sinus)could be involved.This infrequent abnormality can affect persons of any age and is the most important hemodynamically significant coronary artery anomaly.Many are small and found incidentally during coronary arteriography,whereas others are identified as the cause of a continuous murmur,myocardial ischemia and angina,acute myocardial infarction,sudden death,coronary steal,congestive heart failure,stroke,arrhythmias,coronary aneurysm formation(rupture,emboli),or superior vena cava syndrome.Fistulas fromthe right coronary artery are more common than from the left, and over 90% of the fistulas drain into the venous circulation.Most fistulas are single communications,but multiple fistulas have been identified.The natural history of coronary fistulas is variable,with periods of stability in some and sudden onset or gradual progression of symptoms in others.Spontaneous closure is uncommon.Surgical repair of the fistula is recommended for symptomatic patients at risk for future complications(coronary steals, aneurysms,large shunts).Transcatheter embolization of the fistulas have been reported.Direct connection between a major epicardial coronary artery and a cardiac chamber or major vessel(vena cava,coronary sinus,pulmonary artery(see attachments) is the most common hemodynamically significant coronary artery anomaly.Myocardial ischemia has been documented in some patients with coronary artery fistulas who have no evidence of coronary atherosclerosis.

Why is your mitral valve leaking?Is it due to a mitral valve prolapse or is it related to the arteriovenous fistula causing ischemia of the left ventricle?What symptoms do you have? What is the name of the irregular heart beat? RJM

E-mail received:

Thank you for writing me back. Sorry I took so long to answer but I didn't > have all the answers. I did go to the cardiologist on Tuesday and asked some > questions. > > I have 1) irregular heart beat for which I have started taking Digoxin. I > may need to see a specialist in the future for further treatment. 2) A-V > fistua. This is located in the top of the heart. It is an artery which > branches off the main artery of the heart. They feel I have probably had > this all my life and are electing not to do surgery because there are > probably more risks in doing surgery than not. 3) I also have a mitral valve > leak which was reported as moderate on the echocardiogram. They are going to > just watch this. All three things are supposedly separate from each other. > None causing the other. > > I would still like to know the symptoms of an A-V fistula. I guess one would > be shortness of breath. > > Any further information would be appreciated. Thank you so much.

Dr Matthews response:

Then you must have atrial fibrillation or paroxysmal atrial tacycardia? Are you on coumadin to prevent blood clots? Do you know the name of the "main artery" from which the fistula arises?Could it be the left or right main coronary artery or is it the root of aorta itself? Symptoms include chest pain,shortness of breath,easy fatigue, arrhythmias(irregular heart beats),mitral valve problems due to the heart muscle(myocardium) around the valve being weakened due to the lack of adequate blood,since the fistula is siphoning it off to another site! Are you going to get another opinion re the need for surgery?Are you under the care of a cardiologist? RJM

E-mail received:

I assume when he told me it was the "main artery to the heart" it was the > aorta. He said is was at the "top of the heart." No I am not on Coumadin. > The cardiologist did send me to a cardiac surgeon. He advised me he felt we > should not do surgery at this time and told me that I had an unusual case and > he would bring it up before his peers. I haven't heard from him. When I > asked the cardiologist the symptoms of A-V fistula he told me "shortness of > breath." He did not mention the irregular heart beat or the mitral valve > leaking as symptoms (which I have). He felt they were not related. I have a > shortness of breath worse at times. If I walk upstairs or go up and hill. I > do walk the treadmill and walk outside but it is not too bad unless I start > up a hill, etc. The doctor said it would be much worse. I have tightness in > the chest from time to time and I have a pain at times in the center of my > chest and sometimes to the left of center between the shoulder and heart, > again not severe but noticable. > > When I had the angiogram I saw the fistula. They pointed it out. The only > way I can describe it is an area that is omitting smoke-like - I assume blood > being release - there one a large area which I assume was normal and then an > area which was emiting about 1/3 of the large area. They said that was the > fistula. > > Hope this is not too confusing for you. I probably will have a second > opinion. We have a Mayo here and the Ariizona Heart Instutute (Dr. > Dietrich). Any suggestions. The surgeon I saw was at Southwest Heart and > Lung.

Dr Matthews response:

The Mayo Clinc has an excellent reputation,and should they decide that the fistula should be ligated or plugged with bead like structures,consider going to Rochester for the repair! If the fistula is large enough,it can suction off enough blood to make the myocardium ischemic and unable to support the mitral valve and hence the leakage.Of course, it could be just coincidental.Have you had a stress cardiolite ECG test to determine if you have ischemia as the cause of your chest distress and shortness of breath? RJM?

E-mail received:

Dr. Matthews, > > I am a fairly active person. I dance ballet 2 times per week and try to > practice yoga daily. Before one of my yoga classes, we were asked to > take our heart rates for optimum exercise benefits. I noticed my heart > rate was about 54/bpm. In the mornings it is usually 47 or 48. The > instructor told me that was a slow rate. Naturally, this caused > concern. I am 24, 5 feet 0 inches, and 105 pounds. Although I am not a > marathon runner, I try to stay active and eat well. I had heart surgery > when I was 4-years-old for repair of a heart murmur. My past echos came > out normal. My last echocardiogram--last month--came out normal and the > cardiologist said he did not see anything that would require further > testing. My heart rate was a bit elevated during the echo, due to > anxiety and nervousness. I did a bit of research on bradycardia and > now have elevated concerns about my heart rate and its normality. I > rang my cardiologist, and the secretary was a bit rude with me, saying a > small person who is moderately active can have a resting heart rate of > 48. > > My questions for you are: > > 1) Is my heart rate--47/48 BPM when I wake in the morning--normal for > someone of my age and size? > 2) When I practice ballet, my heart rate does elevate to approximately > 150 during exercise; does this still indicate bradycardia? > 3) Can an echocardiogram diagnose bradycardia? > 4) Although, at times I do feel fatigued, I have never fainted or > experienced blackouts. If I jump rope for 1 min, my heart rate goes up > to 140-150. Is my heart responding normally to exercise? > > > Thank you for your attention. I look forward to your feedback. > > Kindest regards, >

Dr Matthews response:

Please visit my website at http://www.rjmatthewsmd.com/Definitions/bradycardia.htm

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. Syncope(or fainting)may occur in individuals without evidence of heart disease a result of profound reflex-induced bradycardia(slow pulse rate).The term vagovagal syncope is applied to such episodes because the entire reflex arc is located in the vagus nerve system.Syncopal episodes associated with painful stimulation of the endobronchial,pharyngeal,laryngeal,or esophagueal muscosa are most probably based on this mechanism. Vagally induced sinus bradycardia(slow pulse),sinus arrest(no pulse),nodal bradycardia(pulse originating in the AV node),second-degree AV block(with a slow pulse), and asystole(no pulse) are the mechanisms responsible for the profound bradycardia(slow pulse) and syncope(see below the discussion of bradycardias which may lead to syncope). A very slow pulse rate can be tolerated,so long as the amount of blood pumped out of the left side of the heart per minute is adequate to oxygenate the brain and the other parts of the body. Once the heart is unable to fullfill this requirement fainting will occur. For example, the 24 hour EKG Holter recording of an asymptomatic 18 year old male athlete shows a slow heart rate of 30 per minute, while he was sleeping (the parasympathetic nerve was stimulated to cause the heart rate slowing with one junctional slowing escape beat). But during exercise his rate went up to 180 a minute with a normal PR interval.No symptoms developed during long term followup (see figure 93b). Normal Heart Rate Normal range of heart rates in the afternoon has been reported to be 46 to 93 beats per minute for men, and 51 to 95 beats per minute for women. Nocturnal rates are slower, decreasing during sleep by an average of 24 beats per minute in young adults and by 14 beats in those over 80 years of age. Trained athletes are prone to bradycardia (slow pulses) with heart rates below 40 beats per minute common at rest. In view of these findings, the American Heart Association current guidelines for pacemaker implantation (a battery powered,lithium-iodine type, electronic,pulse generating device embedded under the skin of the chest, just below the right clavicle usually, and connected to the right atrium and/or ventricle by a sterile wire, which is guided through the cephalic vein) advise the following: 1. Episodes of sinus bradycardia with heart rates as low as 30 beats per minute, which cause no symptoms, are to be considered with in the normal range. 2.Also,normal are sinus pauses (no P waves) of up to 3 seconds (see fig 16, second EKG) and atrioventricular nodal Wenckebach block, where the PR interval successively increases until a P wave is finally not followed by a QRS on the EKG (see fig 17, second EKG).

In view of the above,I believe your pulse rate is normal and that its response to exercise is normal.Normally an electrocardiogram(ECG) is done along with the echocardiogram,so that it is possible to note the heart rate.Even without the ECG,one can note if the pulse is slow or fast.One can wear a 24 hour Holter machine to record all of one's heart beats,but it does not appear that you need one at this time. RJM

E-mail received:

> Thank you very much for you prompt and very thorough reply. I have one > last quick question. Again, my resting heart rate is 47 BPM (morning > count.) I was told by my yoga instructor to do 2 min. of jumping jacks > and if my heart rate was above 125, that was a bad sign. My reading, > after 2 min. of jumping jacks, was 140. Is my instructor, indeed, > correct. Also, I practice ballet moderately, once a week, which > requires a lot of jumping. My heart rate does increase to about 140 > during such jumps, but about 2 min. later recovers to 60-90 BPM. > Concerned, I went to a Physician who said she wasn't sure weather or not > that was normal. My ECG came out fine, according to her, but I am > confused. Is this high heart rate, obtained from mere jumping, normal > for someone with a slow hear rate? Should I take a stess test to test > my heart rate? > > Thank you for all your attention,

Dr Matthews response:

I do not believe that your trainer is correct!I believe that your response is within a normal range.But ,yes, get a stress test to ease your apphrension! RJM

>You sound very healthy to me!You should reread the information I sent > >you!Your pulse will rise with exercise,and the degree depends on your > >prior conditioning and other factors.Unless you are an expert at > >counting your heart rate,it is advised that you not count the > >pulse.Instead if you continue to be concerned, I would consult a > >cardiologist re whether you should have a stress test!I* would not > share > >your health concern with anyone other than your specialist,and > certainly > >not a layman!

E-mail received:

You are absolutely correct. I should not share my pulse info. with > anyone other than a doctor or cardiologist, as it just causes anxiety. > I really wish "laymen" would keep their opinions to themselves. This > "layman" also happens to be an acupuncturist, who one would figure would > understand the body a bit more. > > Thank you, Dr., for all you help and reassurance. I think it is > wonderful the way you can communicate to others via your website. What > a help! > > Kindest regards,

Where do you hold you practice, as I cannot seem to find the information > from your website (very helpful and informative site!) > > Kindest regards,

Dr Matthews response:

My pleasure!

I am mainly at Mission Heart and Vascular Clinic,1801 W.Romneya Ave.,Ste. 105, Anaheim,Ca.,92801;1-714-778-0900;Tues.-Thurs.
RJM

 

E-mail received:

Dear Dr. Matthews: > > I have many GI problems, high blood pressure, and PVCs. > > I was recently in the hospital with Bradycardia. > > Do the PVCs affect the blood pressure and pulse rate? > > When I take my pressure & pulse they show a wide variation from time to > time and even when retaking it within about five minutes.

Dr Matthews response:

No!PVCs do not control the heart rate or blood pressure.Heart rate and blood pressue are controlled by the nervous system,including the autonomic one,which consist of the parasympathetic and the sympathetic ones,which in turn are controlled by centers in the brain(see on my website http://www.rjmatthewsmd.com/Definitions/autonomic_nerv_syst.htm).

Why were you in the hospital for bradycardia?What was found?Are you on medication for the blood pressure?What are these medicines?How old are you?Do you drink alcohol,caffeine,or smoke tobacco or grass?

E-mail received:

Dear Dr. Matthews: > > Thank you for responding to my e-mail. > > Back in 1991 I was hospitalized for depression and given large doses of > Elavil (Etrafon) which I feel caused the PVC's (extra heart beats). > > At that time I was on Norvasc (2.5 mg.) and LoPressor (25 mg.) - 3x per > day and a small amount of Klonopin. I was diagnosed with a hiatal > hernia, GERD, IBS, Gastritis, and diverticulosis. Was also on Zantac > which caused my liver enzymes to go out of sight. Since then have tried > all the PPI's, but cannot tolerate them because of diarrhea, gas, > headaches - very sensitive person. > > Over the years I lost weight and my blood pressure med was cut down to > 25 mg. of LoPressor 1x per day with several bouts of anxiety and > depression. Tried many antidepressants, but unable to tolerate the side > effects. Complained of severe headaches and went to a Neurologist and > had several MRI's of the brain. One neurologist said the headaches > could come from the LoPressor and after reviewing the MRI's personally > was diagnosed with between 5-10 mini strokes in the frontal lobes, while > the radiologists reports indicated scattered focci. > > To date have had three nuclear stress tests all showing PVC's with no > blockages. On 81 mg coated aspirin daily. > > In November of '01 was hospitalized again in Telemetry because of > ventricular bigeminy. While there room changed and had an upper GI and > endoscopy which revealed severe reflux, hiatal hernia, chronic gastritis > and had my gallbladder and many stones removed, laproscopically. > > Since that time I have just deteriorated terribly. Again in May of '02 > was hospitalized for severe anxiety and depression. On LoPressor, 25 > mg. 1x per day depending on my blood pressure, Famotadine (Pepsid) 40 > mg. 2x per day, Celexa 50 mg. per day, Neurontin - approx. 1200 mg. per > day, trazadone to help the Celexa work better and occasional Adivan. > Again had upper GI which revealed the same severe reflux, hiatal hernia, > chronic gastritis and colonoscopy which revealed IBS, diverticulosis, > multiple large tics, lots of gas (put on metamucil), spastic colon, > spasms of the esophagus and rectum, severe contractions and esophageal > motility disorder. > > Had another MRI of the Brain in May because of the headaches which was > compared to the previous MRI. Again the same neurologist from the group > I use said 5-10 mini strokes and another neurologist from the same group > said no neurologic damage - hardening of the arteries. Got a third > opinion from another source which said no neurological damage. Had a > carotid Doppler test - negative and spine MRI which showed small spurs > and bulges with small disc herniation without cord compression. C--3-4 > mildly impinges on the ventral aspect of the cord. Came out of the > hospital worse than when I went in after three weeks. > > Had a 24-hour pH test and manometry test and was diagnosed with severe > motility disorder in the esophagus. Went to a laproscopic surgeon with > the hopes of having esophageal surgery but told that even if he fixed > the sphincter I was not a candidate for the fundoplication because of > the gas and motility problem. > > Because of severe chest pains on left side of chest, right side of chest > and middle of chest and arm pains, right and left and not making any > progress, only getting worse have gone to the ER on several occasions, > had many EKG's because I thought I was having a heart attack. > > In November of '02 went to a holistic dr. and he looked at the EKG's, > called my cardiologist and sent me straight to the hospital, diagnosed > with bradycardia (said my pulse rate was in the 20's) and put me in > telemetry. My pulse rate has since gone up. What can be done to raise > the pulse rate even higher? Any comments or suggestions? > > Medication changed from LoPressor (which they feel caused the > bradycardia) to Norvasc 2.5 mg. 1x per day (take with Tylenol) which > still gives me terrible headaches when it dilates the blood vessels, 5 > mg. of Klonopin 1x per day and 10 mg. of Lexapro which I have since > stopped because of coughing, bronchitis, nasal stuffiness and mucous. I > can't believe that the LoPressor caused the bradycardia because I had > been on it for so many years. Was also put on Catapress 1 mg. at night > (changed to a half) also gave me headaches and woke me, put on 1500 mg. > of Gaba 750 which woke me with headaches and Melatonin 2 mg. which also > woke me with headaches and chest pains. The holistic dr. said I was > toxic and severely anemic. He wants me to get a pacemaker; and have a > physiological test (like angiogram). He feels there is something wrong > with the rhythm of my heart. It fluctuates constantly. My cardiologist > says definitely no. > > Since I have been on the Norvasc things have gotten progressively worse, > in constant pain (head) most of the day and the Norvasc is definitely no > good for the reflux and gastritis. Even my cardiologist says he gets > headaches from the Norvasc. Have tried Cozaar with similar results. > Just got the cardiologist to change my med to 16 mg. of Atacand 1x per > day which my husband found on the Internet, but have not started it yet. > > Have been to several GI drs. who can't seem to help me. One said I have > a very sensitive GI track. Their only answer for the motility problem > is an antidepressant. Was recommended to a Dr. Fischer at Temple > University in Philadelphia, who supposedly specializes in this problem, > but am not able to make the trip. They in turn recommended a gastro dr. > in NYC who did absolutely nothing. It was a wasted trip. We have > checked a GERD board on the net and many people swear by Xanax. > > I get different types of headaches - on the left side - constant - when > I take the Norvasc moves to the top of the head where the blood vessels > are being dilated, throbbing on the top of my head, back aches, arm > pains, lips, teeth, face (some type of myalgia). The Norvasc and > Klonopin and Famotadine also cause severe muscle tightening in the colon > and full of gas. Do not eat any gassy foods or milk/cheese products or > gluten products. Do you know of any other calcium channel blocker that > does not cause headaches and muscle pains? > > Recently diagnosed with cervical spasms/ severe neck, shoulder and arm > pains and pains in the lower part of the back of my head. Go to > physical therapy. Thought I had Fibromyalgia - went to a chiropractor. > Also went to a pain management specialist who is an anesthesiologist and > he gave me two shots of Novacaine in my back and has now prescribed > Magnetic Field and Lazer Therapy. Do you know anything about this? > > I am 63 years old, do not smoke, drink alcohol, caffeine and definitely > do not smoke grass. > > Get some relief from Konopin but don't want to live on that as it is a > controlled substance and habit forming. Take about 1.5 mg. per day. > > Is there a connection with the nervous system, serotonin levels and/or > vagus nerve? Is the blood pressure and pulse rate regulated by the > brain? Is this a neurological or cardiovascular problem? > > We have done a great deal of research work on the Net. I feel I have > had more brain damage; not paralyzed in any way, shape or form - have no > feelings whatsoever on the right side of my head (refreshness, hunger, > ambition, desires) since the beginning of December. Do you feel it wise > to have another MRI? > > I used to be a very active go getter with a very responsible job and > everything has hit me at once. > > My blood pressure and pulse range as follows: > > When get up about 123/75 - pulse 53 > > About 4-1/2 hrs. after .5 Klonopin 133/62 - pulse 36, 123/64 - pulse 54, > 115/67 - pulse 41, 118/63 - pulse 45. > > Two hours after Norvasc 120/64 - pulse 33, 129/70 - pulse 49, 136/61 - > pulse 56. > > My cardiologist and PCP are both at their wits end and even though there > are several physical problems here they say if the depression and > anxiety were lifted I would get better, but I do not agree with them. > > Where are you located? > > As you can see I have a multitude of problems and feel that they are all > interconnected somehow because they all seem to act up together. > Stress??????? > > Had right breast lumpectomy and radiation about 12 years ago and > subsequent to that a cyst in the same breast. Left kidney stone > lithrotripsy. Melanoma right shoulder - removed at very early stage. > MRI of liver, spleen and pelvis which revealed spots - followed by bone > scans of above and whole body bone scan - all negative. Gallbladder and > stone surgery. > > Your reply would be most appreciated. Thank you. >

Dr Matthews response:

You certainly have had great workups including getting wonderful advice and care from your physicians.I am sorry that you have so many side effects from your medications. Your examining physicians would be far more helpful than I could ever hope to be ,especially since I have not examined you nor reviewed your records. The calcium channel blockers all have side effects to one degree or more! I am not familiar with laser and magnetic field treatments for neck problems. Yes,the vagus nerve is part of the autonomic nervous system and among other things causes the pulse rate to slow depending on various stimuli, and counterbalancing sympathetic nervous system. Blood pressure and pulse rate have regulatory centers in the brain,which are affected by a multiplicity of factors outside the brain to maintain homeostasis through their effects on the heart ,blood vessels, and other structures. Only your neurologist can decide on whether you should have another MRI! Stick with your physicians.I think they doing the best they can for you! RJM

E-mail received:

I am a 55 year old male, 6'3" and 250 lbs. I have recently had several > episodes of rapid heart beats in the 150+ range and requested and > received a ECG from a local medical facility. The info from the ECG is > as follows. > > > > Vent. Rate: 70 bpm > > PR interval: 112 ms > > QRS duration: 82 ms > > QT/QTc: 380/410 ms > > P-R-T axes: -72 -14 13 > > > > Also included on the report was the machine comment: > > > > ***Age and gender specific ECG analysis *** > > Unusual P axis and short PR, probable junctional rhythm > > Abnormal ECG > > > > I would like to know what these results mean and what they may portend > for the future.

Dr Matthews response:

Can you send me a copy of the ECG as an attachment to an e-mail? The abnormal site of origin of the electrical force to stimulate the AV node to transmit the stimulus to the heart to contract suggest that it may be the source of the rapid heart action you experienced!The future depends on he diagnosis ,which may require a 24 hour ECG Holter test ,stress ECG,Echocardiogram ,and a cardiac electrophysiology test. RJM

While waiting for your response to my initial answer to your e-mail ,I'm sending the section on arrhythmias from my website to read!It should be informative!

E-mail received:

> OK... I finally hooked the scanner back up but it is still giving me a few > problems hence the size of the attached file... it is still clear so you > can read it plainly... > > thanks much...

Dr Matthews response:

Yes,the clarity is good! I can not make a diagnosis of Wolff-Parkinson -White syndrome! But if these spells of rapid heatr action continue to reoccur,then an electrophysiology study would be in order to determine if rasdiofrequency ablation would be benefitual! Keep me informed!

E-mail received:

Many thanks for the diagnosis you can't make. Every symptom given for that > fits exactly with what I have been undergoing. Currently they have just > given me a Holter Monitor to wear for 30 days. I would expect the test you > mentioned may be given next. Failing that, I would expect them to start some > kind of medication regimen. Will let you know which way they go. One > thing I find curious is that they had a ECG made six months ago and it was > almost exactly what I sent you, at least as far as I remember. It also > mentioned the same points. Question is if they had it so long ago, why did > they wait six months to decide to do anything about it? I think you in > particular should have some understanding because of your past experience > with this organization. (chuckle)

Dr Matthews response:

It is hard to say WHY! Maybe, it was machine read and the right person did not catch it! Also, remember you were asymptomatic then? Keep me informed! RJM

E-mail received:

Actually it is very easy to understand why.... from what I have seen, the > ECG was just put into my medical file without even being examined by a > doctor. It was there mainly as a reference in any changes of physical > condition. I would imagine similar circumstances at the other hospitals you > have worked at in Seattle, West Roxbury, and West Los Angeles. Here I > rarely actually see a doctor. the PCT is taken care of by a Nurse > Practitioner instead of a doctor. I had mentioned the symptoms to the NP > which was the reason for getting the ECG in the first place. Not having a > Cardiologist examine abnormal ECGs seems to be a normal practice. I have > found out such events are to be expected. > > Another case in point is after having a barium enema performed, they > identified two possible problems. I was given to understand I would need a > full examination of my colon. What they did schedule was just a descending. > I was told by the intern(?) who was supposed to perform the descending that > he hadn't even seen the BE report and had no idea of any possible problems > or that I was supposed to have a full colon examination. > > I can only hope the hospitals you have worked at are better organized than > what I have seen here. >

Dr Matthews response:

What a sad thing to happen to the practice of medicine! But it is all too frequent! Various pressures from changes in insurance company and U.S. Government medicare policies have accounted for most of this shift in the type of care being given! Many, many of us still work very hard to spend the necessary time to interact with each patient to prevent the lack of communication , such as occurred in your case,despite overwhelming stress! Paying attention to detail and not delegating certain responsibilities to less well trained individuals would help solve the problems.We care,but we need to have time to see the test results etc! RJM

E-mail received:

Dear Dr. Matthews, > > My last echocardiogram revealed I had a "large coronary sinus," leaky > tricuspit valve," and "leaky aortic valve." How serious are all these, > as their terminology sound very scary to me? I did have heart surgery > when I was younger--5 years old--for repair of congenital heart defect, > heart murmer. My cardiologist did not call me back regarding this bad > (if it is) news so I assume it's not severe. > > Can you enlighten me on all this and their severity? > > Kind regards,

Dr Matthews response:

What was the repair of or what was the congenital heart defect, which was corrected? The leaky tricuspid and aortic valves may be minimal and hence nothing to worry about ,except to use prophylactic antibiotics for surgical procedures to prevent valve infection.But the leakages have to graded as to severity! Can you copy the echo. report and send it to me as an attachment! RJM

E-mail received:

> Hello, Dr. Matthews: > > Many thanks for your prompt reply. I must call my cardiologist's office > to get a copy of the echo. Will he give it to me in form of a tape or > CD--which I could then send to you--or can he send it to me via e-mail > and then I can consequently e-mail it to you. The repair was for a > heart murmer (I had a hold in my heart) which was then covered-- with > teflon, I beleive. As a result of the hole, I had a muscle build up in > my left atrium--one of the valves there had to be cleared out. You may > remember me. This is Luana Gerardis; I wrote to you previously > regarding sinus bradycardia. I hope the incognito e-mail at first was > not offensive, but I felt a bit awkward and embarrassed approching you > with another question, which is a bit more personal; so, I decided to > address my question through a relative's account. I would be both happy > and relieved if someone else could offer a second opionion regarding the > matter. I do have to premedicate prior to dental work, if that offers > any more light on the matter. I will call the office on Monday to see > how I can obtain the information. However, what if my cardiologist in > Montana will not send me the echo? Could I have the cardiologist send > you the tapes perhaps, if they will not release them to me? Just a > thought. > > Thank you for all your time and attention, all of which has been so > greatly appreciated. > > Kindest regards,

Dr Matthews response:

The cardiologist most likely will send you a copy of the report,which you can scan and send as an attachment to an e-mail to me!Or you can fax it to 1-310-821-8097! Was the defect an atrial septal one,or a vntricular septal one? The mitral valve is the one which allows blood to flow from the left atrium to the left ventricle and out through the aortic valve.I suppose the mitral valve is the one you had some sugery on! RJM

E-mail received:

> My cardiologist will send me the echo. report. As soon as I recieve it, > I shall scan it and send it over to you. It may take a week. Will that > suffice?

E-mail received: OK

> Dear Dr. Matthews, > My name is Joseph. I am 8 years old. I have Shone's Complex, but I > am not sure what that means. All I know is that I "have a bad ticker". > My mom said that it was okay to write and ask you. Next week I will > have another heart cath in Cleveland, Ohio. I have a scar on my chest > from open heart surgery when I was 4 or 5. But, now I want to know more > about my heart. Please write to my guidance counselor. > > Thanks,

Dr Matthews response:

The data below is quite technical.I am sorry!Let me know if I can help further!

E-mail received:

On my aunt's CT r

Dr Matthews response:

During the scan

E-mail received:

I have a 88 year ol

Dr Matthews response:

Possibly the tin

E-mail received:

Dear doctor, >>>I am 37 yr old and a family history of heart problems.I had a heart >>>cath >>>done about a week ago and they said I had 25% blockage in one artery >> >>and >> >> >>>15% in another.But they also said I was boarderline lv.What does >>>Boarderline lv mean? >>> >>>Thank You,

Dr Matthews response:

The "lv" abbreviation is difficult to know!Lv could mean the left >>veventricle.Borderline might mean that it is borberline enlarged!Why > > did > >>you have the heart cathetrization? What had been found previously to >>cause them to do the catheterization! >>RJM

E-mail received:

I had one done about 2 yrs ago and it showed some blockage in the 25 >>to 30% range and I have have chest pain for a while,more like >>pressure.So my dr wanted to check again to see if it had gotten >>worse.He also stated that my heart was a little week what ever that >>means.I don't feel like he is telling me everthing or explaining what >>is going on.Do you know what needs to be done about my heart being >>weeek?I have been taken advacor for my chlosterol and nifedipine and >>foltex.He said it was to keep the blockagefrom getting worse.What do >>you suggest? >> >>Thank You,

Dr Matthews response:

How much exercise are you doing? Are you short of breath ?What brings on > > your chest pain and where is this pain and where does it radiate and how > > long does it last ? What bring it on? > RJM >

Do you have another name for foltex(is it folic acid,a vitamin),as I can not find it in the PDR.Why are you taking it? What is your cholesterol? Do you have high blood pressure? Have you had an echocardiogram performed to see if there is any structural damage to your heart and its valves? Or is the trouble in your left ventricular muscle due to hypertension or what? Since the coronary arteries are not significantly blocked,there has to be another cause for the "borderline LV"or the heart "being weak".Did you have a stress ECG test?.The nifedipine ,a calcium channel blocker, is often used for cornary artery blockages and the resultant chest pain called angina pectoris,but your blockages are not severe! Maybe, there is another explanation(Could you have the X-syndrome or myocardial bridging)! Do you smoke and drink heavily(As such factors can cause trouble)? RJM

E-mail received:

I do try to exercise,I am only 135 pds.In the summer I exercise the > most.The chest pain comes on when I least expect it like driving to > work,sitting watching tv or walking in mall.It only last a few minutes > usally but sometimes for 5 to 10 min.It feels like a hand is sqezing my > heart and a lot of pressure ,when it happens my front side of neck > seems to effected and sometimes my left arm. > Thank You,

Dr Matthews response:

The folic acid helps to stop the hardening of the arteries.The echocardiogram does not have the power to see blockages of the arteries,but it can measure the narrowing of valves! Since your angiogram and stress test were normal ,I doubt that the chest pain is due to your coronary arteries. I definitely would stop smoking!! I think your doctor is doing all he can,but maybe you are not understanding everything he says to you.You should feel free to ask him anything about your health,especially to learn why your left ventricle is a "little weak" and what does he mean by these statements and why! Is he a cardiologist?Could it be that you are consuming too much ethanol? RJM

E-mail received:

Yes he is a cardioligist.What is ethanol?I have a follow up with him >>in a couple weeks.I'll ask him about this stuff. >> >>Thank You,

Dr Matthews response:

> Alcohol is what I was getting at!You'll have some data and questions > to ask him and then get back tome!

Yes,there is a condition of the heart called alcohol cardiomyopathy in which the left ventricle can be "weakened".You have to be willing to answer the tough questions to learn if there is anything wrong and why!So do not be sensitive,but believe that physicians care and hence we ask many questions to "help you".No embarrassement! RJM

E-mail received:

Thank's for your help.I have a lot of questions to ask my dr.I only > drink once in a while.I might have 3 glasses of wine a week.Do you think > I should not drink?Thanks again for emailing me.

Dr Matthews response:

Ordinarily,a glass of wine a day is helpful to the heart.But since I do not know what is wrong with your left ventricle(Your Doctor said it was a little weak),I would advise you to discuss it with him!I do not feel that the 25% narrowing of the coronary arteries is what is causing the LV problem(although it is important to do everything you can to reverse the atherosclrosis)!But again your physician knows more about your condition! So I think you have gained a few thoughs to discuss with your Physician! Stay in touch! RJM

E-mail received:

My daughteerned Mother

Dr Matthews response:

You ar

E-mail received:

dr matthews i do.

Dr Matthews response:

You mayin 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

E-mail received:

Dr. Mathews: I am trying to better understand what is "Calcium Score" and how I can relate it to my EBCT result. I am a 63 year old male. I recently had a EBCT cardiac scan at Harbor-UCLA Medical Center in Torrance, CA. My result was: Artery Location: Calcium Lesions Calcium Score Left Main Coronary 1 1 Left Anterior Descend 0 0 Circumflex Coronary 0 0 Right Coronary 2 2 TOTAL 3 3 Primarily my question is: Can you have a "Calcium Score" different that the Calcium Lesion? As you can see mine are the same? How should I best interpret my result. I do understand my score is in the bottom 25th percentile for age and gender. Thank you.

Dr Matthews response:

No,the lesion and the score can be the same at a particular site.It takes two adjacent pixels to get a score of one, indicating the presence of calcium and a lesion in the artery. Apparently the computer grades or calculates the number or intensity of the calcium in an area (0 to say 500). Those with scores below 100 and age 60+ do not have signicant stenosis (see table 1 at above definition, my site) RJM.

E-mail received:

Why do heart patient's have enlarged livers?

Dr Matthews response:

http://www.rjmatthewsmd.com/Definitions/congestive_heart_failure.htm
The above site explains why and how left ventricular heart failure causes increased back pressure in the right ventricle and swelling, fluid in the liver,abdomen,legs etc.RJM

E-mail received:

I'm 23 years old, female with family history of heart disease and then some. I just had an EKG done because I was having some spells with dizziness, my chest feels tight (but it feels tight a lot without the other symptoms) feeling like I was going to pass out, hot flashes (I got hot inside), blurred vision, sick to my stomach, palpations. The last time I had it it was preceded with a weird feeling in my left hand (I don't know if it's related or not) it felt like someone was sticking pins in it. The EKG said occasional premature supraventricular complexes, normal sinus rhythm. (computer print out) Vent. rate 70 bpm PR interval 136 ms QRS duration 90 ms QT/QTc 374/403 ms P-R-T axes 81 88 71 What does this mean? Is it something I should have checked out? Attached is a copy of my EKG report. I called my doctor's office and he is gone on leave and they don't know when he'll be back. Is this something I should worry about? I'm currently living in Germany on a military installation. I would prefer to hear an opinion from a civilian American doctor. I'm a 24 year old female with a family history of heart disease along with other things.

Dr Matthews response:

Please refer to my website :http://www.rjmatthewsmd.com/Message/m.htm
Here you will find correspondence concerning palpitations and associated symptoms,recommended tests and treatments!You will no doubt need a 24hour Holter ECG study or incident ECG tape recorder study to capture the episode for analysis and possibly an echocardiogram and a stress ECG treadmill test to rule in or a structural heart problem. RJM

E-mail received:

How much blood in gallons does the heart pump in 24 hours?

Dr Matthews response:

The output of the heart is expressed as in terms of square meters of body surface area (as cardiac index,or liters per minute per square meter of body surface area(mean is 3.4 and the range is 2.8 to 4.2).So if 4 quarts equal a gallon, then 3.4 times 60 equals 20.4 quarts per hour.Then 20.4 times 24 hours equals 489.6 quarts or 122.8 gallons(463.4liters)! RJM

Email received:

What are the risks with a first diagonal angioplasty and would you use a stent?

Dr Matthews response:

Patients under going coronary angioplasty are subject to the same complications encountered with the performance of coronary arteriography.In addition ,because instrumentation of the atherosclerotic lesion occurs,coronary dissection,thrombus formation,and coronary spasm may occur,leading to acute occlusion of the coronary artery or side branches arising from the artery.Acute occlusion of the dilated aretery is the most common serious complication of coronary angioplasty and accounts for most of the morbidity and mortality related to the procedure. Five preprocedural predictors of a major complication include: multivessel coronary disease,presence of calcium in the lesion,female gender,and lesion length.The strongest predictor of a major complication in one study was the appearande of intimal tear during the procedure,increasing the risk of a major complication sixfold. In one study of 4772 patients there was a 4.4% incidence of acute occlusion,for which 4 preprocedural risk factors were identified :bend point location,branch point location, thrombus in the artery, and the presence of other stenosis greater than 50% diameter narrowing located elsewhere in the vessel dilated. Of egual importance is the estimate of the consequences if acute occlusion occurs.This estimate is determined in large part by the amount of myocardium that is supplied by the artery that is in jeopardy.Occlusion of a small diagonal branch is of little conseqeunce compared to the occlusion of a large left anterior descending coronary artery that is also supplying collateral vessels to an occluded right coronary artey.In the first case, a small non-Q wave infarction is likely,whereas inthe latter, occlusion would likely result in abrupt anterior and inferior ischemia and be associated with hypotension and possibly cardiogenic shock.Immediate bypass surgery may be life saving,but myocardialinfarction will occur in at least 50% of patients and there is significant risk of mortality in this subgroup of patients. Nonangulated segments(less than 45 degrees) have a greater success rate than moderately angulated ones (greater than 45 degrees,less than 90 degrees), and excessively angulated ones(greater than 90 degrees) have low sucess. There are many other anatomical factors as well! The stents came about to prevent restenosis, but about 20% still restenose,unless radiation is given.In experienced hands,like you physician, the decision will be made by your anatomy! You should discuss your questions with your cardiologist!RJM

Email received:

Dear Robert Matthews, Thank you for your very full reply, much food for thought there. As I already have an occluded LAD, which is being backfilled through collaterals by way of the first diagonal which is 70% narrowed proximally, I think the cardiologists are divided between angioplasty and a bypass - some for one, some for the other. A "narrow" decision, as it were, that at present seems to favour the former. Any further comment most welcome, but I will discuss it as you suggest. Thanks once again.

Dr Matthews response:

Thank you for telling me more about the anatomy of your coronary arteries.So the first diagonal is very important because it is feeding a very large area of myocardium. We have evidence that stent placement is unanimously indicated for the treatment of de novo or restenotic lesions situated in large vessels (approximate 3mm in size). Smaller vessels constitute a large group in daily practice of percutaneous coronary interventions.Interventions in small coronary vessels(less than 2.8 to 3.0 mm) account for a considerable proportion of the greater than 1 million catheter- based procedures world wide each year. Small size is a risk factor for restenosis.In recent studies it is evident that stenting of small vessels leads to results equivalent to or better than those achieved with PCTA.It has also been found that is better to stent than to settle for a sub optimal post-PTCA result. Current studies do not discourage the routine use of stenting for lesions in small coronary arteries;they only show that a strategy based on optimal PTCA with provisional stenting is probably as effective over the long term as the alternative strategy of systematic stenting.There is hope that coated and drug-eluting stents represent promising new technologies that could turn stents into highly attractive devices for treating lesions in small coronary arteries.RJM

E-mail received:

Dear Sir: I am currently a student at WTAMU and am very interested in the field of cardiology. I am a 37 year old caucasian female with a family history of heart disease. My question to you would be can stress play a significant role in perpetuating heart disease especially if the person also has a family history against him as well. If so, what recommendations would you make to aid in keeping one's stress levels at a minimum? If you would be so kind as to email me at mdg126@yahoo.com Thank you for both your time and concern in this matter. Respectfully,

Dr Matthews response:

Yes,stress can induce atherosclerosis ,at least as a contributing factor. Stress can activate the sympathetic nervous system,adrenocortical,renin angiotensin systems, which then contribute to endothelial cell dysfunction. Abnormal endotheliun becomes an ineffective barrier unable to retard platelet and monocytes from adhering to the blood vessel wall.In this situation, excessive release of growth-promoting factors and increased infiltration of lipids into the vessel wall may lead to rapid progression of the atherosclerotic lesion. Lipid level have been shown to rise under stress.Increased activity of the sympathetic nervous system influences lipid metabolism.It may inhibit lipoprotein lipase activity, leading to elevated very low density lliproproteins (VLDL )triglyceride and decreased high -density lipoproteiin (HDL) cholesterol levels. Sympathetic activation may also increase cholesterol by impairing LDL clearance. The big question is how to keep the stress to a minimun!It is very difficult for me to advise in the area of psychiatry and pschology. It would be more appropriate for me to refer you to those skilled in related problems, of which you write!So my best answer is that you consult with the the exprets in this field! RJM

E-mail received:

Dr. Mathews, I have two questions for you. The first has to do with blood pressure and the second with exercise. First, some background: I'm a 46 year old athletic male who was diagnosed at age 30 with a bicuspid aortic valve. Periodic ECGs have shown no stenosis but moderate regurgitation and a slightly enlarged left ventricle. The enlarged LV was suspected to be due possibly to my athletic endeavors (competitive swimming, running and cycling as well as sporadic weight training) since childhood, so, this did not alarm my doctors. Until the last ECG, there appeared to be no change in size. The slight enlargement between the last two ECGs (3 year span) has prompted a follow up ECG in 6 months and a warning about weight lifting but no other recommended mitigating actions. Also, my healthiest weight as an adult has been 185 and I have in the last three years hit 200. I continue to cycle and typically include very high intensity training with exercise HR in the 150s and 160s, repetitive efforts that hit the 170s and occasional sprints and climbs that hit my max of about 180. My last stress EKG measured my systolic BP at 234 when I hit my maximum BP, which was cause for some concern. The questions: 1) Blood pressure: Should I be on blood pressure medication? I do get systolic readings in the 130s fairly frequently and the latest research indicates high average BP readings represent a surprisingly increased cardiovascular risk factor. I've received conflicting views from two different cardiovascular surgeons on this, one saying "leave it alone for now", the other saying, "don't wait, get it under control now". 2) Weight lifting: Not "should I" but "how can I"? There is long established information and opinion that weight lifting increases inner heart pressure, which, in the case of someone with valve problems and/or ventricle enlargement can be especially injurous. But there has to be a safe amount and /or technique for weight training. I would think weight training with moderate weights and proper technique and breathing is probably safer for my heart than carrying furniture, heavy groceries, or even forcing a bowel movement. I've been told to "take it easy on the weights" but I need to know what that means. Simply cutting my weight in half across the board is not really helpful. For example, I'd like to know if an exercise that works the chest from an upright position is safer than one that does so with equal resistance from a prone position. Similarly, is it safer to work the back in a rowing motion while in an upright position using a pulley mechanism versus being bent over and lifting equal resistance against gravity? I suspect the answer to the first question will be a simple matter of opinion. The second question is probably more complicated but very important to me. I hope you can help. Thanks.

Dr Matthews response:

First I am concerned when you e-mail that you are having "Ecg's" alone rather with than "echocardiograms"! I presume you mean that you are having echo's, since you know that you have moderate aortic regurgitation and a recent increase in left ventricle size.I suspect that it is not the exercise, which has caused the increase in left ventricular size, but rather the aortic regurgitation!If the effects of the regurgitation are advancing ,one needs to remember that there is an ideal time for aortic valve replacement before the effect of left ventricular dysfunction become irreversible, in spite of valve replacement! Have you had a left heart catheterization to study the situation in more detail? I would discuss in more detail these things with your your cardiologist ,since he is the only who has examined and can advise you! It appears that you have gained too much weight ,and you should correct this situation, which should help your exercise hypertenion.I do not like the exercise BP of 240 systolic, but your resting BP's of 130+ lead me to want to get you to lose weight first prior to starting BP medicines! Incidently what are your serum lipids and your heredity! I would resolve the above questions prior to talking about weights,which can be addressed to a physical fitness trainer!RJM

E-mail received:

Dear Dr.Matthew. In May last I was diagnosed with early hypertensive hypertropic cardiomyopathy. Is the same as hypertropic cardiomyopathy. Also diastolic heart failure I have a copy of echo but all I have been told is to take b.p.tablets and lasix. Also on prednisone, and arava for rhuematoid arthritis, Serevent and Flixotide for possible asthma. I am trying to get some info so as to help myself, or is this not necessary until perhaps later stages. Came upon your site recently and thank you for any possible info you can suggest.

Dr Matthews response:

Send me a copy of your echo test!Where did the word hypertensive come from? Do you have high blood pressure? What are the numbers of your my blood pressure?What are your symptoms fro the diastolic heart failure? In the meantime, Look at my site at http://www.rjmatthewsmd.com/Definitions/cardiomyopathy.htm
What are the pills you are taking?RJM

So you do have high blood pressure,which has caused the walls of the heart to enlarge and thicken. Whether this condition is causing your shortness of breath or the asthma is not clear to me. Let me ask you some questions:1) Have you seen a lung specialist(a pulmonologist) re your asthma? 2) Have you had breathing,lung tests done?3) Have you seen a cardiologist for the shortness of breath and chest pain? I would advise that you seek the above consultations and go through further tests to find out what will make you better! You may need a heart catheterization, 24hour Holter test and other tests to learn more about your heart and lungs. There are medicines called beta -blockers, which can help some patients in heart failure, but they aggravate asthma and hence are contraindicated for you. Digoxin and hydralazine come to mind, along with the lasix and potassium you are taking. See my website re heart failure:http://www.rjmatthewsmd.com/Definitions/heart_failure.htm The main thing is to consult further and not give up!RJM

E-mail received:

Thank you for quick reply. Echo.Clinical details. Known patient with dyspnoea and palpitations. Has Rhuematoid arthritis. Quekry cause of long stnading dyspnoea. MMode & L.V.Function Measures. Interventricular Septal Thickness (diastolic) 1.4cm L.V.diastolic 3.6cm. L.V.systolic 2.1cm.Fractional Shortening 42%.Left Ventricular Posterior Wall thickness 1.3cm. Aorta 2.4cm Left Atrium 3.3 (Atrial area 12cm2).Right Ventricle 2.2cm Ejection Fracture 74%.DOPPLER MEASURES. aORTIC VALVE PEAK GRADIENT 8MMhG, MEAN GRADIENT 5MMhG. mITRAL VALVE PEAK e VELOCITY 0.6M/SEC. PEAK a VELOCITY 1.0M/SEC. e/a RATION 0.6. tRICUSPID VALVE PEASK trVELOCITY 2.6/SECOND, RIGHT VENTRICULAT SYSTOLIC PRESSURE 38MM hG. Left Ventricle Cavity size slightly reduced at 3.6cm. Global systolic function normal. There is mild to moderate concentric left ventricula.r hypertrophy noticed.Early suggestion of anteroseptal ischaemia +. Right Ventricle normal Left Atrium Normal Right Atrium normal.Aortic valve appearance leaflet excursiom normal. Mitral Valve. Appearance leaflet normal with reversal of E/A velocity noticed (marked).Tricuspid Valve Appearance normal with slightly increased right ventricular systolic pressure of 38mmHg noticed. Pulmonary valva normal. Aorta Normal. Pulmonary Artery normal. Pericardium Normal. Conclusions. Findings consistent with early hypertensive hypertrophic cardiomyopathy with marked reversal of E/A velocity and mildly elevated right ventricular systol pressure of 38mmHg. Early anteroseptal hypolinesis. Findings suggest diastolic heart failure. This could be partly responsible for shortness of breath. 25/5/01 sob has got worse. Angina ruled out on Thallium Scan recently. Medicines. Arava and Prrednisone 7mg Arthritis. Aspirin 100mg daily. Avapro 75mg daily.Lipitor 10mg.daily.Lasix 40mg daily.Premarin o.624mg.Span K 600n mg. 2 tabs daily. Serevent and Flixotid one or two puggs twice a day. Nasonex or Budamax aq 100 mcg once daily.I presume it is Asthma. Saw G.P. today and he said no one knows what it is. Did'nt help me as what to do when coming up from garage and steps and can't breath, chest burning, and have to wait until pain eases, and breathing is enough to move. Making Bed or doing dishes, or just talking is'nt quite so bad but enough to have to stop. Thankful for any ideas. Will go to your site again.

Dr Matthews response:

I looked at the side effects of avapro and coughing is not mentioned. I still think you should see a lung specialist(asthma specialist) and another cardiologist for another opinion and further investigation!You should do this immediately and doing so may save your life, which is so precious! You are on medicare and hence you can go to any specialist you choose to be reevaluate your condition. Your treatment needs reevaluation too. What is your cholesterol, LDL, and HDL, blood sugar, thyroid test results. Remember the other medicines I mentioned!RJM

E-mail received:

Thanks again for your reply. My Father Mother Brother and Sister all deceased had strokes.Father had high bp,Mother had three strokes , Brother had asthma diabetes glocauma (went blind) had a massive stroke died at 57. Sister had high bp had stroke unable to move or talk for two years died at 75. glaucoma kidney failure blind in one eye as Mother was i am 69 (70 in February) next. Have'nt any records except death certs. Same diagonis three years ago by cardiologist but he left hospital and Drs. said no was'nt heart.Had a lot of stress with Husband seriously ill for 5months earlier this year and thought that was the cause of palpitations and bp. Was in the range of 160-170/ 95-100. Now 1 hour after taking Avapro it was 100/70. 16 hours after it is 130/80. Chest pain not too bad unless I do something. Cough very worriesome ?Medicine causing this. Asthma maybe. Thanks again

In reply to yours of 5/12/01. Last cholesterol non fasting was around 6 not sure. No other results. Saw G.P. on 4/12/01. He does'nt know what to do. Wrote to cardiologist the only one coming up monthly to nearby town, he has'nt replied. i don't want to sound over anxious so thanks for your comments. I shall show these to G.P. and see if I can get a referral or at least some tests. Thyroid never been tested as far as I know. Most appreciative of you listening to me. Thank you.

E-mail received:

Just to update you and thank you again for giving me the "guts" to push for second opinions.Am going into Hospital for reviews and observations. Quote:-Thallium Scan SUGGESTS NO blockage of coronary arteries so pain unlikely angina. Breathing studies not normal. Number of explanations including inflammation of lung tissue from Rhuematoid Arthritis. Respiratory Physician coming in for second opinion. Heart muscle not working normally.Pain may be chest cage and thoracic spine and s.o.b. from heart & lung tissue. Very complicated and not easy to reverse" Your advice made me contact the rhuematogoist in whom I have a lot of faith. G.P. would'nt do this. Thank you again wish you were here in Australia.

Dr Matthews response:

I'm delighted with you! Now we can find out what is going on ! Keep me informed!RJM

Page 1 | 2 | 3 | 4 | 5