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Avatar universal

We are concerned about truth from doctors.

My 45 year old husband blacked out at the wheel of car 5/9.  On 5/10 the cardiologists put in a pacemaker because his heart kept stopping.  Prior to this, symptoms his doctor ignored were: sudden onset of heartburn; fatigue; leg cramps; achiness; could not work out at gym anymore (from 4-5 days per week prior).  Doctor prescribed (without a stress test that we requested because of high concerns of health, but doc did not want to be told what tests were needed), prescribed him Celexa for fatigue, nexium for heartburn and doxazosin for frequent bladder.  He was told that one or two of the doxazosin as needed per day.  He took two on 5/8 for the first time, but no one gave us info on the drug.  Now he has a pacemaker, they also did TEE test and discovered a leaking valve (aortic insufficiency), a positive tilt test showed neurocardiogenic syncope for which the cardiologist has prescribed Toprol XL.  My research shows that this drug should not be taken if slow heartrate is a problem, which his is.  His resting heart rate is 55 or so, lower in sleep, about 45, so the pacemaker kicks in at 50.  Why then, Toprol?  I'm losing faith in docs, so please provide some advice. Thanks!  side note, he also has had a heart cath, no blockages, but something about the aorta being extended?  The doctor suggests that his weightlifting may have caused this, but he used to lift only 285 once in a while, mostly cardio workouts with weights.  He's 6'1", 215 pounds, very strong upper body.  Would the doxazosin have had something to do with the heart damage and disease now?
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Avatar universal
Annie Hall,
Aortic Insufficiency (AI)is a strange valvular abnormality to acquire without some underlying problem.  The AI could be contributing to his previous fatigue and inability to work out at the gym.  Furthermore, AI can be caused by tears in the aorta, which might explain his "heartrburn".  It sounds as if his aorta should be investigated by a cardiologist with experience in this area.

Toprol XL is a recognized treatment for neurocardiogenic syncope.  It is indeed contraindicated in patients with slow heart rate, but not if they have a pacemaker.

I can't think of how the doxasozin could be contributing to the conditions described.

Hope that helps.
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Avatar universal
This sounds like a terrible time for your husband and you.I am very shocked that a pacemaker was implanted without any testing unless they felt that the heart could not adquately beat on its own to maintain hemodynamics.In regards to the Celexa, it is a antidepressant and would not be used in fatigue unless there was documented evidence of major depression.The Toporol is a beta blocker and will decrease the heart rate even more.Is the pacemaker on demand or continiuos? I experienced a syncopal episode several years ago where I lost consciousnesss and my heart rate was out of controlThey found arrythmias as well as a leaky mitral valve.I didn't even know I had The leakage from the valve causeed cardiac enlargement and set off the cascade of arrythmias cusing loss of consciuosness .I would go to a academic medical center and get a nother doc who can help you two as well as answer your questions,allow you to participate in your care and explain what is happening and why he is recommending the things he is.The aortic insuffecieny needs to be evaluated by a cardiac surgeon, it may require repair.Take your TEE with you to that large academic center for care and see both a cardilogist and a cardiac surgeon.Good luck
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Avatar universal
Yes, they felt the pacemaker was necessary to save his life.  The last episode before they put an external pacemaker on, was 12 seconds flatline without any warning at onset.  The external went off 20 times in the night before surgery.  I realize Toprol is a beta blocker, but why with a pacemaker is it necessary?  He has a cardiologist and EP now, plus a good internist.  He's just a mystery patient at this point.
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Avatar universal
Dear Annie,
First let me say I am so sorry - there are no words to express how hard this must be for both of you. The issues with the aortic valve and the aorta itself that you describe make it very important that he be seen by specialists on the aorta. Given your husband's age, it makes me wonder if there is an underlying congenital (from birth) factor that is surfacing now as he reaches middle years. This is what happened in my husband's case. While individual symptoms can be different, failure of the aortic valve and problems with the aorta are very very serious, as you are experiencing.  
Regarding the aortic valve, was anything said about the shape of the valve being different from normal? Was the degree of insufficiency (leakage) described to you? You mention the word "extended" regarding the aorta. Did anyone use the word "dilated"? Did they use the word "aneurysm"? Did they mention the size, location, or shape of this "extension"? It is extremely important that this be understood, and from the TEE they have that information.
Major academic medical centers generally have the strongest expertise, based on research and latest technologies. Even among them, there is only a subset that have expert specialization in aortic disease. You need that very best expertise. And when you find it, there should be little or no mystery, given current expert knowledge and diagnostic capability regarding the aortic valve and aorta.
I am sorry to hear that a heart cath was done when there is a problem with the aorta. There are safer, non-invasive ways to determine the condition of the coronary arteries in this situation.
I would be glad to share with you the results of my search for expertise for my husband. Finding the right expertise made all the difference! Please feel free to email me at ***@****


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