Interesting question. There's not a lot known about the intersection between the inflammatory diseases, like scleroderma, and coronary artery disease. Evidence would suggest that a sustained heightened inflammatory response may well contribute to the atherosclerotic process but much work remains to be done.
For your patient, there are a few other things that I would want to know. First, what are her current symptoms such as chest pain? Second, what was the reason that she underwent heart cath? For example, did she have an abnormal exercise or other imaging test? Third, where (in what artery and the location) is the 90% blockage specifically?
PCI (stents and balloon procedures) can be done on small diameter blood vessels but the risk of re-narrowing is higher than in larger blood vessels. Some of the technical approach would be based on an assessment of symptoms and how much those symptoms might be attributable to that blockage. It's always worth a second opinion. Get another cardiologist to take a look at the cath films while providing him/her the details on your patient's history etc.
I'd need to know a bit more information to really be helpful (basic things like your age, history of heart disease or other medical problems) but in general, SA (sinoatrial) node dysfunction can indeed be a serious problem. The SA node controls the start of the electrical system of your heart beats. The electrical impulse starts in the SA node then after passing through the upper chambers of the heart (atria) travels through the AV node into the lower chambers (ventricles). These electrical impulses cause the heart to contract or beat. As we get older, the electrical system of the heart can work less well (like many things as we age!). Sometimes this is a condition that the doctors just watch but sometimes this results in the need for a pacemaker. Talk with your doctor as to what your ECG findings mean and what the treatment options might be.
You pose an interesting question as to what to make of this percardial biopsy reading. Much of this interpretation is what we see with chronic, nonspecific inflammation of the pericardium. Lots of things can cause this including viral infections. These can also be associated with pericardial effusions (as you experienced). Or, these type of inflammatory reactions can also be seen after chest trauma as can be experienced in a car accident. Bottomline is that many things can cause a pericardial effusion, even recurrent ones. I'm bothered by your continued symptoms of nausea and fatigue. It's worth mentioning to your MD and asking if infectious and inflammatory causes of pericardial effusion have been evaluated as some of these can also cause the kind of symptoms that you are experiencing.
After a heart attack and with the starting of new medications, the increase in sweating could well be due to one of the changes in your lifestyle (ie working out more actively) or with some of the medicines. If you otherwise feel well, I wouldn't worry too much about this as long as the increase sweating doesn't interfere with your lifestyle. But if it is really bothersome, ask your doctor as he/she might choose to switch your medications around a bit to see if this annoying side effect can be lessened.
This is good question that raises some important issues. First, the most important thing that you and your husband should do is to have an open/honest conversation with his doctors (likely both the primary care and Washington Hospital Center doctors). You should encourage your husband to have this conversation as soon as possible so that the doctors have time to either get some additional testing if needed or to provide you advice that might require additional travel planning.
Second, one of the reasons that heart care has become so aggressive with things like stenting and surgery is so that patients can return to a level of activity that fits their lifestyle. As a cardiovascular community, we want patients to return to the things that they love to do (work, exercise, travel, etc) and not necessarily to "slow down." Now, we do want patients to take care of themselves through diet, exercise and medications. But we want to also encourage active lifestyles whenever possible.
The travel question is complex. Some of this will depend on any and the extent of heart damage. Some of it will depend on other health problems that your husband might have. And, some of it will depend on how the trip will be made (ie easy access to medical care if needed? ability to stop for a rest or a brief walk, etc).
Please talk with the doctors. My wife and I are bringing our youngest daughter to college next week. I wouldn't want to miss it either if at all possible.
Best of luck. Please let us know how things work out.
First, I am sorry to hear about the loss of your son,
Coronary stenting has been a major step forward in alleviating chest pain symptoms in patients with coronary blockages. Unfortunately, while a major advance over balloon angioplasty, stents do still re-narrow in some patients to a point where repeat procedures are needed. If you have recurrent symptoms and a positive stress test, especially showing decreased blood flow (ischemia) to the area supplied by the stented blood vessel, it is possible, maybe even likely, that your doctor will want to perform a heart catheterization to examine the previously placed stent but also other non-stented areas as well. Based upon the results of the heart cath, coupled with knowledge of your stress test plus your symptoms, he/she will make a recommendation that will include medical therapy plus possibly a repeat stent procedure. If blockages are very severe, surgery is sometimes also considered.
Bottomline, work with your doctor about what options fit best for you.
Great questions and solid advice given by CardiostarUSA. First, let's talk about the EKG. One reason that doctors use the EKG to look for evidence of a prior heart attack. We look for fairly subtle electrical changes that suggest that a heart attack may have taken place in the past (the electrical signal of the heart passes through dead tissue differently than it does live tissue). But this finding on an EKG is not 100% reliable. The CT scan suggests a low probably of heart blockages but again this is not 100% reliable.
Most importantly, how do you feel and what are your coronary risk factors? Do you smoke, have diabetes, high blood pressure or high cholesterol? As described in CardiostarUSA's reply, most important is to look at this as an opportunity to think about a heart healthy lifestyle. Heart blockages develop over many years and changes in lifestyle need to be prolonged to make a difference.
Good information is provided by CardiostarUSA. Understanding a bit more about the type of stress "defect" is important in helping to decide what it may represent. But even more critical is to understand why you had the stress test in the first place. Was it to assess chest pain symptoms, shortness of breath or other symptoms that suggest the possibility of coronary artery disease? It's important for your doctor to understand the test in relationship to any symptoms that you might be having. This will help him/her to decide if anything else needs to be done (more tests such as a cardiac catheterization) or medical therapy.
Definitely get follow-up on this from your doctor and good luck.
These are worrisome symptoms: shortness of breath and passing out. After a bypass operation, these symptoms could reflect some damage to the heart leading to heart failure symptoms (the shortness of breath), continued abnormal blood flow to critical areas of the heart (also the shortness of breath) and/or a heart rhythm problem that led to the syncope (passing out). These symptoms warrant a very careful evaluation by your dad's doctor and an explanation. This sounds like more than the "normal" healing process.
I suggest that you (or another family member) accompany your dad to his doctor's appointment and make sure that the doctor fully hears the story that you write about in your note. This really needs follow-up.
Great question and fantastic additional data provided by Cardiostar USA! As someone who loves and collects wine, I was particularly interested in this question and thought that I might chime in. First, how did people come to the notion that red wine might have some heart healthiness to it? There's an observation called "the French Paradox" (http://en.wikipedia.org/wiki/French_Paradox ) that emerged when scientists noted a relatively low incidence of coronary heart disease among the French, despite a high incidence of smoking and a diet heavy in fats (cheese, creams, etc). This notion gained widespread attention in the 1990s after it was covered in a story on 60 Minutes. It was spurred a great deal of scientific intrigue into whether or not a moderate amount of red wine consumption might balance some other dietary indiscretions.
Bottomline, we don't know the answer definitively. Most believe that a modest amount of daily alcohol has some health benefits. Some believe that this benefit is pronounced with red wine, due to some particular chemicals that are part of the grape skin. In fact, companies have been formed to explore whether some of these compounds might be extracted and developed as drugs to treat/prevent heart disease.
Now, back to your question. While drinking fine aged red wine is truly a delight, there's no evidence (yet) to suggest that this might be better for your health than more simple, less expensive wines. The key is moderation!
So, enjoy your glass after work or with dinner tonight and stay tuned for more evidence as the story evolves.
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