What you describe appears like a condition called Raynaud phenomenon. This is an exaggerated response of blood vessels to cold temperature or emotional stress. In your case, either stress or cold weather might be causing blood vessels in the big toe to decrease in size which in turn leads to decreased blood supply thereby causing toe to turn blue. When you warm up, blood vessel comes back to normal size and recovers its normal shade. There are multiple conditions like scleroderma, systemic lupus erythematosus, other connective tissue diseases, occlusive vascular disease, drug effects, hematologic abnormalities, and use of vibrating tools which can cause Raynaud phenomenon. I recommend that you visit your primary care doctor so that work up for Raynaud phenomenon can be done and the exact cause can be identified.
Angiography was indicated when you were having heart attack. After the acute episode had passed, opening up the closed coronary artery will not recover the dead heart muscle. So angiogram may not help at this point. However stress test will give information whether other coronary vessels are diseased. If stress test is positive, then an angiogram is needed to open up affected coronary vessel. Further more after heart attack, pumping capacity of heart decreases. So it is very important for you to take right medications which will help improve pumping capacity of heart and prevent you from getting heart failure. I recommend you to continue to follow with a cardiologist for further management.
Typical presentation of anginal chest pain would be chest discomfort or tightness( not sharp type),brought on by exertion, and improving with rest with radiation to shoulders, jaw, or inner arm. In a study looking at patients under age 40 who presented with heart attack, 80 percent smoked cigarettes, 40 percent had a family history, 26 percent were hypertensive, and 20 percent had hyperlipidemia It is highly unlikely that the sharp pain in someone as young as you would be heart attack related unless you have most of the above risk factors. It appears that the symptoms are more likely due to anxiety. However coronary vasospasm is common in women and cigarette smoking can make it worse. I advice you to stop smoking if you can.
What you describe appears like premature atrial or ventricular beat. EKG may be normal when you are not having these episodes of catch-up beats. Holter or an event monitor will provide information about whether these catch-up beats are actually premature atrial or ventricular beats. It has been reported that prevalence of premature atrial beats among patients with mitral valve prolapse varies widely from 35 to 90%. If holter monitor does demonstrate that these are premature atrial or ventricular beats, I would recommend you to stop any potentially exacerbating habits like caffeine intake, alcohol intake, smoking and stress. Premature atrial or ventricular beats are relatively benign and do not cause life threatening abnormal rhythms.
In a condition called inappropriate sinus tachycardia, patients tend to have elevated resting heart rate and/or an exaggerated heart rate response to exercise. This is different from condition called postural orthostatic hypotension syndrome where patients tend to have normal baseline heart rates and exaggerated sinus tachycardia in response to changes in posture. Tilt table study to rule out postural orthostatic tachycardia syndrome can be performed. Increased heart rate might be due to suddenly standing up, but it is not clear why you do not have symptoms when standing during the day or when you are getting up in the morning. sometimes atrial arrhythmias that arise from the right atrium can look like sinus tachycardia and an electrophysiologic testing may be necessary to determine the exact nature of this arrhythmia.
Both CONCOR and valsartan have been shown to be beneficial in CHF. The combination of beta blocker and calcium channel blocker would slow down the heart rate. In your case, if your symptoms are not controlled with present dose of medications, it might be worthwhile increasing the dose of medications since the pacemaker would prevent the heart rate from dropping to very low heart rate. The other option would be radiofrequency ablation. Post maze atrial flutters can sometimes be challenging but most of them can be successfully treated with mapping and radiofrequency ablation. Contact an electrophysiologist who specializes in complex arrhythmia ablation in your vicinity and seek consultation. You have not been tried on other antiarrhythmic drugs like Dofetalide or sotalol which are worth looking into.
From the information you have provided us , it appears that ECG performed for atrial fibrillation screening showed ST segment changes. The results of ECG are normally interpreted in context of symptoms and history which include presence or absence of chest pain, shortness of breath, palpitations, dizziness and exercise capacity (distance you could before you feel short of breath or experience chest pain). ECG is not recommended in patients who do not have symptoms or who have a low risk of coronary artery disease. ECG alone does not reveal much information in an asymptomatic patient apart giving information about the patient's rhythm. In your husband's case, ECG was performed to rule out atrial fibrillation ( irregular rhythm). I hope the test results showed that he does not have atrial fibrillation.
A recent retrospective study showed that there was no evidence of an increased risk of heart attack, cardiac arrest, or stroke associated with the use of ADHD medications. The FDA also recently (in Dec 2011) relased safety information about a study in children and young adults exposed to certain ADHD medications which did not show any association of heart attack, cardiac arrest or stroke and ADHD use in that population.
The peak levels of Tambocor in blood is seen 1.5 to 3 hours, so the medication kicks in at 8-9 pm after you have taken the medication at 7 pm. Atenolol is taken once daily , in your case at 7 PM daily. It is likely that the levels of Tambocor in blood decrease towards the evening. The dose of tambocor may have to be increased. It is not clear whether you are taking 50, 100 or 150 mg of Tambocor. I recommend that you follow up with your doctor, who might consider increasing the dose of medication. The other possibility is that your AF is simply breaking through. You may need change of the drug or consider AF ablation.
Sore throat and coughing could be due to intubation during general anesthesia. In most patients , these symptoms resolve in two weeks. Also ulceration of esophagus may happen in few patients undergoing AF ablation , but the symptoms resolve over a short period of time. Lets hope that both sore throat and cough resolve in next two weeks. If she continues to have unresolving cough, painful swallowing or significant reflux it is worth mentioning this to her electrophysiologist who performed the procedure.
Dr. Andrea Natale
Dr. Andrea Natale is a board certified electrophysiology expert and practices at executive medical director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas. Dr. Natale also is the Senior Medical Director at Pacific Atrial Fib and Arrhythmia Center in San Francisco. He visits MetroHealth in Cleveland, and Akron General, Ohio. He has pioneered a new circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world's first five patients. For further details Please visit :Link
Dr. Dhanunjaya Lakkireddy
Dr. Dhanunjaya Lakkireddy, MD, F.A.C.C, FHRS. is a board certified electrophysiology expert and practices at Mid-America Cardiology and The University of Kansas Hospital Clinics in Kansas City, KS, USA. He has several distinctions in clinical and research career to his credit and serves as an associate editor for Journal of Atrial Fibrillation.For further details Please visit :Link
Dr. Dhanunjay Lakkireddy, MD, F.A.C.C, FHRS, The Kansas City Heart Rhythm Institute (KCHRI), KS, USA.
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