Several Questions After Prior Silent Heart Attack

[BabsD]

I am a 38 year old female with a history of a prior silent heart attack. I currently take 81mg aspirin, 25mg atenolol, and 1mg folic acid daily, as well as fish oil capsules and a multivitamin. I was diagnosed after a routine ekg and echo were abnormal, and I had a heart cath that showed the scar from a prior heart attack, but normal coronary arteries and an EF of 50.  No cause has ever been determined, although the theory is that it was caused by a blood clot due to birth control pills I had been on.

I get a lot of PVCs, which I was told not to worry about, but I keep reading on this forum that they are only ok if you have a structurally normal heart. What does this mean for me, since I have had a heart attack? Also, my cardiologist tells me that my EF is low normal, but I have read on this forum that an EF of 60 or greater is normal. Who is correct?  Is there any way for me to raise my EF? I now exercise 3-4 times a weeks, although I am still 40lbs overweight, and my total cholesterol is 185, LDL 131, HDL 42, Triglycerides 62.

I am scheduled to have my partially impacted wisdom teeth extracted under IV sedation this week, and I am VERY nervous about the sedation.  Is IV sedation safe for me? Should I refuse it and just get novocaine? Am I at a greater risk for the sedation because of my prior heart attack? Just how safe is IV sedation?  I also have a heart murmur (although my valves are supposedly fine) so I was told to take amoxicillin before the procedure.

Thanks in advance - I really appreciate this forum and look forward to your reply.

[CCF-M.D.-RCJ]

Babsd,

Thanks for the post.

In regards to the PVCs, it is possible, although not probable, that they could be a sign of enhanced potential for other types of rhythm disturbances.  In someone with an EF of 50, they would not warrant treatment unless they were causing symptoms.  We have some evidence, for example, that implantable shock boxes (defibrillators) do not improve survival in someone with a heart attack and an EF of 40 or more, provided that the person does not have symptomatic arrhythmias.  The EF probably cannot be raised above 50 -- unless you have other medical problems (such as untreated high blood pressure) that could be contributing to your low-normal EF.

I can't comment on the iv sedation without seeing you and knowing what the sedation is.  Talk to your doctor about this issue.

Good luck.

[dartmouth03]

Hi Doc, thanks for the answer to my questions earlier.  I just wanted to get your insight real quick on an issue i've been having with my cardiologist.  I've been on a 2 lead king of hearts monitor and most of the tracings are saying that i have IVCD with a qrsd of usually anywhere from .12-.14.  I went over this with my cardiologist and he said not to worry b/c i've had 4 12 lead ekgs 5 months ago that all showed a qrs duration within normal limits with the highest being slightly over .11.  Do you think this is true that 2 lead king of hearts aren't a accurate indicator compared to a 12 lead ekg?  Should i get the ivcd issue checked out by an electrophysiologist?  thank you so much doc.
best,
alex

[dartmouth03]

the highest of the 12 lead ekgs was .114 ms.  
best,
alex

[fitstatt]

I am an exercise physiologist and have a female client age 49 in great shape who was diagnosed as having a Silent heart attack 1 week ago based on ECG and blood tests. She was told to come back in a month for follow-up tests. She told me that she was cleared to workout and has not been put on any meds. Is this accurate ?  She is a type A and hates to skip her workouts.  Is this safe ?