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St. Jude Medical

July 30th, 2014
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long standing AF (15yrs or so) had AF ablation with no affect on AF. meds not working-now on Tikosyn 375 mcg bid. more frequent and some multiple daily episodes. sx sob,light headed,chest/jaw tightness,fatigue,headache etc. have had several tacky/brady episodes with spontaneous conversion-no syncope but close. next step is epicardial ablation i'm told. what do you think. thanks katie

2014-06-09 Answered By : Dr. Young-Hoon Kim,MD, PhD

Answer:In first, to confirm the relation between your symptom and heart rate is important. More precise medication adjustment to release your symptom is needed. Of course, Redo ablation including epicardial ablation can help you. However epicardial ablation is not only one answer. Conversion and syncope related with bradycardia. Medication change and modification also can help you.

hello doctor, my husband had gone through heart attack a few years ago and my husband stress test was abnormal and also CAD,CHF,LV function is reduced and has hypokisis thining scarring and dyskinesis of the apex with an EF fraction of 35 Due to this doctor says that he need defibutator because the front part of the heart wall was completly damaged and they suggested us to join in Loyola hospital in Chicago.Based on these reports please suggest me that does my husband need heart transplantation o else medication is enough.

2014-06-09 Answered By : Dr. Young-Hoon Kim,MD, PhD

Answer:Although reduced LVEF 35%, CAD, CHF, wall thining and dyskinesis, medical approach should be the initial treatment. According to the guideline, the patient is needed for ICD. Considering for refractory medical treatment in the future, you should resgist for heart transplantation. We can recommand the stepwise treatment from medication to ICD device. However, the clinical conditions of patient will be worse rapidly, we consider directly heart transplantation.

my mother has 86years old and before four days my had gone through heart ablation operation for curing her chronic and permanent atrial fibrillation. She Was under general anesthesia for 7 hours after 4 days from the operation and now She is coughing up a lot of bloody mucus still.she has a very sore throat that appears to be getting worse.Is this normal after 4 days? I am Concerned That She is heading for a bout of pneumonia should this be continues. thank you

2014-06-09 Answered By : Dr. Young-Hoon Kim,MD, PhD

Answer:Thank you for your question. I think that bloody mucus may be related bloody tinged sputum. Under general anesthesia, high pressure of endotracheal tube cuffing can make the endotracheal or larynx mucosa damaged. In most case, endotracheal damage is healed spontaneously, however pain killer will relieve her symptom. Sometimes, even though endotracheal tube cuffing, aspiration pneumonia can occur. However, because she did not complaint of infection related symptom, the possibility of pneumonia is less likely. Esophageal fistula or pulmonary vein stenosis can be related with the bloody mucus or sore throat. However those complication occurs at least 3 weeks after procedure.

Hi Doctor, I have a high cholesterol reading of 7.1 with an LDL reading around 4.5. Is there any way to find out how the blocked heart arteries are there or else all the heart arteries are blocked at all? Is cardiac CT scan Useful for finding out or a cardiac MRI and how would these two differ?How would cardiac calcium score differ from the cardiac CT?

2014-06-09 Answered By : Dr. Young-Hoon Kim,MD, PhD

Answer:At first, it¡¯s important to decide the objective of imaging study. Cardiac MRI is more specific for the wall thinning and scar of ventricular muscle. So it is more useful for evaluating patients with wall motion abnormality or evaluating the relationship of coronary artery disease with muscle abnormality. On the other hand, cardiac CT is useful for finding out the artery stenosis. Therefore, we recommend cardiac CT for this patient, because we want to know the stenosis. As stated above, cardiac CT is good for confirming the severity of artery stenosis. Cardiac calcium score is known to be related with the long term prognosis. Life expectancy or clinical outcome can be more related with calcium score than severity evaluated by cardiac CT.

I have gone through congestive heart failure and have been working diligently to improve my health.I have taken some tests to check my cholestrol levels and my test report says that my cholestrol is totally down to 223 and my lung function is much improved.My health has been improved than compared to past days.My question is why I am not making noticeable progress with my Any Edema?could you please explain me?

2014-06-09 Answered By : Dr. Young-Hoon Kim,MD, PhD

Answer:The cause of edema is various. Diligent activity is definitely helpful to your health. However it is not enough to treat heart failure completely. A few medication, for example diuretics may help you. Your effort make your heart healthier. But cause of heart failure correction and medical therapy also upgrade your status

I am 55 years old male.I have my LIPScience cholesterol report,My overall glucose is 117, with A1C of 6.1%. Overall cholesterol is 209 with HDL of 44 and triglyc. of 96.I am looking to loose 70 pounds.I had gone through all the tests required and reports are evaluated like this HDL-P 25th percentile at 27.1 (higher risk CVD) LDL size at 20.9 (Large) at 26.6 percentile, Large HDL-P at 1.3 (low insulin resistant), HDL size 8.3 at small insulin resistant,LP-IR Score of 47 at 50th percentile,LDL-P 1858 (borderline high).which I am not familiar with their reports ,though I don't think I have to freak out,Should i be worried about this reports.

2014-06-09 Answered By : Dr. Young-Hoon Kim,MD, PhD

Answer:LIPScience cholesterol report is a particle concentration and size report, insulin resistance score. It is an index to measure lipid profile and insulin resistance. Prediabetes is diagnosed by demonstrating any one of the following: a. 100 mg/dL ¡Â fasting serum glucose level ¡Â 125 mg/dL b. fasting serum glucose level < 126 mg/dL and 140 mg/dL ¡Â 2hr OGTT (oral glucose tolerance test) ¡Â 199 mg/dL c. 5.7 % ¡Â HbA1c level ¡Â 6.4% Therefore, a diagnosis as prediabetes depends on whether your glucose level is from serum or from the result of OGTT test. Because your total cholesterol and LDL cholesterol level are elevated than normal range, management with medication such as statin or life style modification seem to be needed. Also, your HDL cholesterol level is lower than normal range, so you¡¯d better exercise or modify your diet to improve your lipid profiles.

My husband suffered from an aortic dissection.He took number of medicines to control his heart rate and blood pressure .The tear extends from his heart valve down into his legs bilaterally,stopping just shy of the femoral arteries.He has been asked to undergo a polygraph test, but I have been advised by several polygraph administrators that this may be an unsafe procedure for him.Is polygraph test is unsafe for my husband?

2014-04-15 Answered By : Dr. Luigi Di Biase,MD, PhD, FHRS

Answer:I would need more detail about this test. Can you be more specific? His cardiologist should answer this question.

Hello doctor,My friend had a MI nine years ago.He has an habit of smoking/vaperizing marijuana for three or four of the last years.He told me that by vaperizing marijuana he get sleepness and relaxation to the body.He also gets a heart palpultations occasionally but only when he is smoking/vaperizing marijuana it.He told me that its very hard for me to stop taking marijuana.Is it really critical for him to stop? and I have read mixed reports on marijuana use as causing a 3-5 fold increase in another MI while other studies suggest it actually helps cardiovascular disease.Is this is true?

2014-04-15 Answered By : Dr. Luigi Di Biase,MD, PhD, FHRS

Answer:I would not recommend the use of marijuana

Looking for help. For 3 years I had an extreme high blood pressure, BP = 220--230, only at night. I have a secondary hypertension. High BP destroyed my heart and my arteries. My heart became weak and sick. Having no strength it beats 2 time of normal, palpitating over 100 beats/min at rest and 150--180 when walking. High BP produced A Fib in April 2013. Then, on 9/20/2013 I had an electric cardioversion. But 2 days later it reversed back. In March 2014 I took 3D Echo --- it shows that the left atrium severely enlarge. I have constant heart pains. had no energy, shortness of breath. Every day is a straggle to survive. Also I have angina. Question: can I have 2nd electric cardioversion when my AFib is one year old and I have the above damages to my heart? Thank you. I appreciate your help and attention. Best regards, Alla Gakuba e-mail:

2014-04-15 Answered By : Dr. Luigi Di Biase,MD, PhD, FHRS

Answer:You should consult a cardiologist or an Electrophysiologist. If you are properly anti coagulated a second cardioversion is possible and actually might be helpful to improve your symptoms, although AF may come back again. You should also ask information about ablation and medications to treat your AF.

I have had an unsuccessful ablation 5 years ago. In your opinion does the FIRM procedure developed by Dr. Narayan really produce singnificantly better results than the usual pulmonary vein abaltion? Thank you for being there. Bill Sims

2014-04-15 Answered By : Dr. Luigi Di Biase,MD, PhD, FHRS

Answer:The data on the firm ablation are exiting but will need confirmation in randomized trial. Do you have paroxysmal or non paroxysmal AF? Where did you perform the ablation and with which technique? Please realize that in all non paroxysmal patients and in some paroxysmal patients pulmonary vein isolation alone is insufficient to achieve success. In addition pulmonary vein reconnection is possible after a failed procedure. I would recommend a second procedure.

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