Carotid desease and the heart

[chapo]

Dear Dr, my 77 yar old father is on Simvastatin for CHD and cerebrovascular desease.  He has an occluded carotid (L) artery and I am worried about the so called "low flow" situation in the brain as along side this he has left ventricular diastolic dysfunction.
I have been told that carotid Endarterectomy is not done on an occluded vessel.  I have recently found some web pages indicating that proceedure has been done on the occluded artery more recently.
! Are your surgeons willing to try the procedure in such a case.
! If not, is there no value in a higher rate of perfusion to the brain.
!Is there a set of specific reasons the procedure can't be done on the occluded artery.
Thanks

[Cleveland Clinic]

chapo,

Thanks for the post.

Its not a simple answer. First, diastolic dysfunction will not have in itself impact on the carotid occlusion or flow to the brain.

The main worry related to the heart would be if his cardiac output would be impaired causing low blood pressure and poor perfusion. Also, if he had poorly controlled hypertension which led to the diastloic dysfunction, his risk for stroke or progression of carotid disease on the other side would be increased.

The cerebral (brain's) circulation has some built in back up mechanisms to bypass significant carotid occlusions. Even with the occluded carotid, cerebral perfusion is able to maintain adequacy from these mechanisms.

As long as hes not having active neurologic changes the risk of any procedure on a completely occluded carotid vessel would outweigh the potential benefits gained from opening the vessel.

There are of course no absolutes and carotid bypass and even percutaneous revascularization has been performed at the clinic in specific circumstances.  If you would like evaluation for your father, Dr Jay Yadav, Dr Samir Kapadia, Dr Chris Bajzer, Dr Deepak Bhatt or Dr Alex Abou Chebel are all members of the departmnet of cardiology at the clinic that would be happy to evaluate your father and discuss his options.  You can call 1-800-ccf-care for an appointment.

good luck

[steveki]

Im really mad!!! I dont want to sound diprespectful here, but when is the medicl community going to wake up?? My best friend's good friend just died from her "benign" pvc, pac problem. DOcs just scratched their heads and called it an mi not due to blockage. She was 32 and in excellent shape.

She went to the docs a little while back with flutters but was told they were benign and not to worry...this is the second person i know of personally that has died from this benighn condition.

When will the medical community wake up? This is not benign...when your heart beats funny, there is nothing benign about it...this is why we all who suffer from them know instinctively something is VERY WRONG...thats why we panic and get anxious about it, its our bodys natural response. Its almost like the docs are just covering their own butts in saying that "nothing life threatening was going on when we chacked you.....soooooo  ure ok...then i guess legally, they are covered.

Lets be real...THIS iS REAL!!! We all know it, its a disease we suffer from, it affects our mind and our daily lives, I I believe it IS a signal of something wrong...there is NOTHIONG benign about it!!!!!!

[tickertock]

You have deepest sympathy, I can certainly relate to where you're coming from. My friend's wife died suddenly a few months ago, 33 years old, dropped dead while putting their youngest child to bed. She had no medical history, no palpitations, nothing. Autopsy revealed nothing at all. No MI,PE,aneursym,nothing, toxicology negative. Body was held for over  month, autopsied twice with same results both times, at least thats what I heard.

Assumed that death was related to cardiac arrhythmia, trigger not certain. Last speculation I heard was that it could have been triggered by taking diet pills, still nothing definitive.Bottomline things like this happen, though from what I gather not too often, nevertheless family, friends and even the doctors are left scratching their heads, sure doesn't make life any easier.These are sad stories I sure don't like to hear or even read about as the relatives are left devastated and without any clear answers. Take care.

[madgeOwens]

Just when I think these things are benign I read a post like this and wonder if I should be worried.

[cristabelle]

Dear Sir,
You have my sympathy also, I've been in the same boat with two male family members.  All I can say, is search, be aggressive, (as it sounds that you are!) and find a Dr. who will understand and test you until you are satisfied.  Follow your instincts if you feel something is seriously wrong.
most sincerely,
cristabelle

[calico1]

Sorry about what happened. I wish there reasonable answers to things like that. I'm beginning to feel concerned myself. I just had my 6th month visit to my cardiologist the other day. I saw he checked "palpitation" as his DX. I kept asking him questions about IST. He said that's the 1st time he heard that term. DUH?! He kept assuring me there's nothing wrong with my heart. But he doesn't want to take me out of Toprol. He said he won't change anything. If I'm okay, then why am I still on medications?  I'm beginning to look like more psychiatric patient. I was just lucky I tolerated the med. Well, it took me a while to get accustomed to the side-effects that they don't both bother me that much anymore. Sigh...

[lolathechi]

I am very sorry to hear about your friend, that is truly horrible...

But I think you have scared the **** out of a lot of people... I know you did to me for sure.. Are you 100% certain of her cause of death???

Most of us have been told on here, by NUMEROUS doctors they are benign, they have spent coutnless hours examing patients, reading, going to school, etc.. We have had numeorus tests, some done mutiple times over and over... At some point we have to TRUST our doctors.. they know and see a lot more than we do. We also have to listen to all the countless people on this board who have had them 20, 30, 40 years...

I know from experience STRESS brought mine on full force.. I would maybe have 3 a year before my panic attacks.. and since I have calmed down about them, I maybe now get a few a day..

I had asked a question on here about 2 months ago, what causes us NOT TO DIE from pvcs and the doctor explained that in people who have normal hearts, with normal eletric circuits the pvc ends there, it is impossible to turn into anything else ( hope I explained that right, thats how I read it)

I know everday I live in fear of them STILL.. and I have a constant heaviness, weird feeling, hopefully just anxiety.. But comments like you made make me and I am sure a lot of other people feel worse.. I am so sorry that your friend died... but from everything that 3 doctors have told me, and NUMEROUS articles, on line sources and other people, it just doesnt happen.. People with normal hearts do not die from pvc's... Maybe your friend had an electrical problem with her heart like Chrissy Taylor ( model Niki Taylors sister) ?? I know they found it very hard to find the reason she died, but she did die of a heart problem... Also it might be possible your friend did not have the numerous tests most of us have had done???

I am truly sorry for your loss, please dont take this the wrong way... But I think your post was a little out of line and scared a lot of us... We have to have faith and trust in our MD's and not live our life in fear.. I have already lost close to 2 years living in fear, if I had read your post 1 year ago, forget it, i would have never come out of bed!!!!!! But oen things for certain, we all have to go at some point in time.. Wether it be cardiac or a piano falls on your head.... So for all you guys out there like me, who live in constant fear and cant enjoy life as we used to.. dont let that post set you back... Just remember 1000000000s of people suffer from pvcs everyday and if they were a cause of death dont you think you would have heard more cases of people dropping from pvcs by now?/ dont you think our md's and cardios would give us pacemakes, defibs, etc??? medication?? they dont want lawsuits on their hands!!!!

xoxox JO

[tickertock]

I do sympathize with with steveki for the lost his friend's friend and I can understand how he feels regarding pvcs, pacs and irregular heartbeats, but the fact remains that most persons that die suddenly of cardiac arrest, usually there is an undiagnosed cardiac anamoly present, usually one the cardiac syndromes(ie. HCM,Brugada,Long Qt, or rarely WPW).Hope they find out exactly what happened.

I take comfort that after suffering for 20+ years with PVCs , Pacs and bouts of tachycardia they aint did me in as yet, probably never will either. I understand all the concern , but for those that suffer with these ectopics , I wouldn't let this me take bed for it, although I can certainly understand how steveki feels and certainly understand what a lost and shock this must be for her loved ones.

[Momto3]

lolathechi

I remember your post because I loved the way you phrased your question.  As someone who had thousands upon thousands of pvcs (couplets, triplets, nsvt, all combos) for over 20 years, I want to reassure you that my doctors still consider them benign.  The only time I ran into trouble (aside from the anxiety) was when I developed cardiomyopathy.  However, that being said, that didn't happen over a short period of time...it took YEARS and constant arrythmias, and even then it is very rare.  I was supposed to be written up for a case study, but my "pictures" (echos) weren't clear enough for publicaction.  Anyway, b/c of the CM (and a leaky mitral valve), the doctors wanted to be aggressive at getting my rhythm in sync. So, I had two ablations to correct the frequent, persistent pvcs.  Absent the CM, I'd still be flip-flopping away and other than feeling weird, I'd be coined healthy.  Please try not to worry as it will consume you. My own EP has pvcs so she has a vested interest in understanding them and you gotta believe that if she thought they were malignant,  she be on the ectopic bandwagon.  Instead, she maintains in the VAST majority of cases, they are absolutely benign and of no significant medical concern.  Of course, if they become bothersome, there are medicianl therapies available. Try not to worry.

stevie

I'm very sorry to hear of your loss. I'm sure it's very painful to bare the loss of someone so young. However, I'm not convinced that a history of pvcs was to blame for your friend's friend's death.  Perhaps more information will surface as the professionals delve deeper into her personal medical situation. Please try not to let your fear of pvcs take over.  Try to relax and wait for more information.  If they weren't benign, I wouldn't be here today.  My pvcs accounted for 24% of my heartbeats for a very long time.  Because of the high frequency of ectopics, I ended up with a cardiomyopathy.  However, with medical intervention, my EF improved to normal and I am no longer dependent on medication to keep in sinus rhythm.  That's after taking BB's since the early 80's (on/off).  I hope you find this somewhat reassuring as you try to find answers for your loss.  

My deepest sympathies to you and all those that were affected by the loss of your best friend's friend.  Take care.

[lolathechi]

It is just sooooo hard to accept these awful things as benign.. I was doing really really well for 3 weeks, with maybe 2 or 3 a day!!! I had put them out of my mind.. I said finally after close to 2 years, these are OK to have and wont kill me.. I try to read the messages on this board often, just for support.. knowing that there are people like me out there.. I personally dont know any.. But it gives me so much comfort knowing that there are others who feel them and fear them and have a  hard time accepting them.. NO ONE ( family, friends, boyfriend) understands what i go through on a daily basis.. They USED to consume me.. so bad I needed to lay down when i had bouts of them.. and in fear to go a lot of places in case they came and I would have no place to cry and lay down... So FINALLY I started getting over these fears.. Then i read that post and the first night, I was fine.. then for the past two days thats all i coudl think about.. someone possibly dying from pvc"s??? I tired to convince myself of my post.. listen to the MD's, listen to all you guys on here who have had them for years... but that one post keeps sticking in my mind, Yesterday was a awful day. non stop pvc's, went to bed I swore I would die in my sleep... I was beyond scraed.. today I was better this AM, then all afternoon skip after skip.. and some of the scary ones.. those looooong ones that feel like your heart just isnt going to beat again.. Then the horrible feeeling I cant even explain, it is like a heaviness or something coating the entire inside of your body.. not short of breath, but kind of like you can breathe well..........

I keep reading both of your posts over and over.. trying to let your words take place of the post of the girl who DIED of pvc's.. but it is so hard.. I thoguth I was going to be a lot stornger and be fine with that post, but it took me for a ride!!!

I keep feeling like the MD"S missed soemthing,, that the 2 seperate times I wore the holter my heart seemed fine.. and it did not record anything other than simple pvc's... I know I am a hypochroniac ( no idead how to spell) but I live in constant fear of my heart every day!!!!

[Momto3]

I can hear the fear and frustration in your "voice."  Have you thought about asking your doctor for an "event monitor?"  Given that the fear is so prevalent, it might help for you to be able to capture some of the feelings that are so scary for you.  I can remember recording some of those long, weird rhythms. It still was not medically significant, but it helped me to know that the doctor could SEE what I was feeling.  That might be something you want to talk to your doctor about.  Also, has your doctor ever suggested beta blockers.  They sometimes help to suppress of reduce the ectopics.  I'm so sorry that you are so frightened.  I really and truly do not think that pvcs caused this young woman's death.  I'm betting there is more to it...I'm not a doctor, just a fellow pvc patient.  Please take care of yourself and follow your instincts until you feel satisfied.  It will give you greater piece of mind if you are comfortable with your own situation.  I know several people who suffer with migraine headaches and until they were convinced they were "benign," it was soooo scary.  Probably similar to those of us who are plagues and frightened by pvcs. Just doesn't FEEL right.  Take care!!  

Oh, if it helps, in the early days of my pvc trouble, I had the same experience as you....could not explain the feeling to anyone, and no one understood.  I had to find a doctor that I trusted and someone I knew who "got it."  That helped a lot!!!

[tickertock]

Please try and stop worrying, You sound very frightend by reading that particular post.

I am not a doctor, but remember how many people out there that died suddenly from an irregular heartbeat that never felt their heart "flutter" in their life, it is alot than those that felt theirs flutter.

For us that suffer in fear all its take is one post like that to cancel out all the positive ones we read.I know exactly how you feel and still battle with the fear of the irregular beats though i hardly have anymore of them, but I refuse to let them cripple me and rob me of enjoyment.

I understand this person's concern, heartache, frustration and sorrow also, but I don't think any person just dies from simple pvcs, usually persons that die suddenly usually have some undiagnosed congenital cardiac anamoly, if you had an a ECG, holter, echo and stress test and all those are normal the chances of anything bad happening to you is very very minute.Take care and try to stop worrying.

[lolathechi]

I am so scared.. today was a little better.. I tried to get my mind frame back... that they are ok to have and wont die from them... I am so sick and tired of not living life the way I used to..

How did you break free of the fear and of having them?? I truly believe they are mind over matter ( well atleast for me).. I know I bring them on.. Somedays I just am too lazy to talk myself out of them and want to feel sorry for myself all day long??

Thank you so much for your post ;-) I wish I could be stronger like you!! ;-)

[lolathechi]

I told myself, no more holters, no more echos and no more cardios for atleast a year LOL... I went to 3 different md's, had numerous tests and told myself, I am being ridicouls now, you have to accept their diagnosis and move on.. there are people who have serious heart problems and they would love to only have the bothersome plain ol' pvcs... The last md I went to said I will look at your holter and then possibly give you a event recorder.. he deemed it un nececceasry when the holter results...

It is sooooo hard to accept these feelings.. I am so glad to know others understand what I go through ( well not glad they have to suffer to.. but atleast I know I am not going crazy!!!)

Thanks for your kind words and support~!

[Ama-Nana]

I have experienced heart pvc's--flutters--been diagnosed with mitral valve prolapse and much more for a great deal of my life.
6 episodes put me in the hospital and 1 was called a heartattack.
My Systolic straight-lined during an angio gram.  Though I didn't have a blockage, I had a vaso-spasem.  Half of my heart died, but has fully recovered now.

I was placed on Cartizem and other meds which only temporarily helped.  It was when I did the research on line that I found some real solutions.  

First of all a Free-form Amino Acid called TAURINE helped immediately.  It regulates the electric pulses of the heart muscle.  Also, I had to eliminate grapefruit, watch my weight and stay away from over the counter meds like anti-histimines.

I have also been diagnosed with Hashimotos disease--(Low Thyroid) I found that what affected my thyroid, had consequencial affects on the rythm of my heartbeat.  

Coconut will strengthen the thyroid and so does avacado and therefore soothe the heart muscle.
Broccoli and other carcivious foods have a negative affect on the thyroid, and thus affecting the heart negatively.

Make sure your calcium,potassium and magnisium are tested on the high side rather than the low.

One test does not fit all-- Man has created a scale from A-Z and tell us what the general population determines as normal readings. However, we are all uniquely made and for some of us--it's normal to be abnormal.  Find out all of your weaknesses--not just your heart.  Be willing to adjust your lifestyle to acommodate your uniqueness.  Then, pray for your heavenly father to give you peace--thank him for his son and have faith that your life has a purpose.  Find your purpose and live within your healthy boundaries.