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[
{
"from": "human",
"value": "My daughter ( F, 18 y/o, 5'5', 165lbs) has been feeling poorly for a 6-8 months. She had COVID a couple of months ago and symptoms have are much worse in the last month or so. Symptoms seem POTS-like. She feels light headed, breathless, dizzy, HR goes from ~65 lying down to ~155-160 on standing. Today she tells me HR has been around 170 all day and she feels really lousy. (She using an OTC pulse ox to measure.) She has a cardiology appt but not until March and a PCP appt but not until April since she's at school and it's a new provider. What to do? Is this a on call nurse sort of issue? Or a trip to the ED? Or wait till tomorrow and try for an early appt? Try a couple of Valsalvas? Wait it out until her cardio appt? Or? She's away at school if Boston, what to do? Thank you"
},
{
"from": "gpt",
"value": "If she actually has a HR of 170 that is accurate, ongoing and persistent, she needs to be seen in the ED immediately."
}
] | My daughter ( F, 18 y/o, 5'5', 165lbs) has been feeling poorly for a 6-8 months. She had COVID a couple of months ago and symptoms have are much worse in the last month or so. Symptoms seem POTS-like. She feels light headed, breathless, dizzy, HR goes from ~65 lying down to ~155-160 on standing. Today she tells me HR has been around 170 all day and she feels really lousy. (She using an OTC pulse ox to measure.) She has a cardiology appt but not until March and a PCP appt but not until April since she's at school and it's a new provider. What to do? Is this a on call nurse sort of issue? Or a trip to the ED? Or wait till tomorrow and try for an early appt? Try a couple of Valsalvas? Wait it out until her cardio appt? Or? She's away at school if Boston, what to do? Thank you | If she actually has a HR of 170 that is accurate, ongoing and persistent, she needs to be seen in the ED immediately. |
[
{
"from": "human",
"value": "Im a 37 y.o. transgender man with pre-diabetes and high cholesterol/triglycerides. I had chest pain and dizziness several months ago and went to cardiology for tests. Stress echo was normal, though the symptoms were still made worse with the exercise. I was sent for a CT scan with contrast. No blockages or abnormalities. They did find a small hiatal hernia. I asked if that could cause chest pain and they reluctantly admitted that it could. I say reluctantly because despite my results being normal, she wanted to put me on a stronger statin. Ive been on statins for years and it has impaired my glucose tolerance. Rather than go on Metformin, I opted to go on strict low carb diet, monitor my glucose and lots of walking. Ive done that for two years and Im almost back in to anormal A1C. Ive worked very hard. I also switched from Simvastatin to Pravastatin. The latter has some preliminary findings suggesting it doesn't effect glucose tolerance as strongly. One of the worst statins for this...is Crestor. The cardiac nurse is convinced that I need to be on it. So I tried it for a month and surprise - my glucose is impaired again. (Morning was usually 160 at worst, two days ago it was 300. My diet has not changed.) I said no thanks to the Crestor and asked to be put back on Pravastatin. Nurse was really pushing back saying its still worth the risk because my cholesterol was too high on the Pravastin. I agreed to double my dose of it until we sort out this dispute. I get a call today from the cardiologist resident who was approached by the RN about my refusal to take Crestor. I get the same spiel about how its worth the risk. I explain patiently that A) I show no signs of heart disease. B)that my chest pain was very likely the hiatal hernia (which will be addressed separately)C) That although I understand their logic, I have worked very hard to keep my Diabetes controlled without Metformin. The common side effects of which (fecal incontinence and nausea) Ive seen with my sister and would very much like to avoid. Cardio Resident says she will \"consult Endocrinology but they will likely say the same thing\". Add to this that Im on Testosterone Cypionate , which she says can cause the triglycerides to read high. I told her to make sure she mentions this when she talks to the Endo. I feel like I am being forced onto a medication that I dont consent to. Here are my questions: 1) could Testosterone cypionate cause a false high reading of triglycerides on a blood test? 2) Am I being foolish in my refusal of the more aggressive statin? 3)Are there other options I am not seeing?"
},
{
"from": "gpt",
"value": "How high is your cholesterol? Since youre only 37 and they are pushing statins pretty hard, I would assume that your cholesterol sucks and you almost certainly should be on atorvastatin or rosuvastatin if it is being recommended by two cardiology providers. Small hiatal hernias do not generally cause chest pain, and for sure do not cause dizziness. If your chest pain was worse with exercise, its concerning for micro vascular disease, with a normal CT.Overall while statins do increase glucose intolerance, they overall have a net benefit in decreasing risk of heart attack and stroke. While your glucose numbers may change, its less about the glucose numbers and more about reducing downstream effects.It is kind of silly frankly to avoid metformin without knowing if youll have GI side effects or not. You likely will unfortunately need metformin in the future, statin or not, and if you dont tolerate metformin there are other alternatives out there such as GLP-1 agonists and SGLT-2 inhibitors that also help with cardiovascular risk."
}
] | Im a 37 y.o. transgender man with pre-diabetes and high cholesterol/triglycerides. I had chest pain and dizziness several months ago and went to cardiology for tests. Stress echo was normal, though the symptoms were still made worse with the exercise. I was sent for a CT scan with contrast. No blockages or abnormalities. They did find a small hiatal hernia. I asked if that could cause chest pain and they reluctantly admitted that it could. I say reluctantly because despite my results being normal, she wanted to put me on a stronger statin. Ive been on statins for years and it has impaired my glucose tolerance. Rather than go on Metformin, I opted to go on strict low carb diet, monitor my glucose and lots of walking. Ive done that for two years and Im almost back in to anormal A1C. Ive worked very hard. I also switched from Simvastatin to Pravastatin. The latter has some preliminary findings suggesting it doesn't effect glucose tolerance as strongly. One of the worst statins for this...is Crestor. The cardiac nurse is convinced that I need to be on it. So I tried it for a month and surprise - my glucose is impaired again. (Morning was usually 160 at worst, two days ago it was 300. My diet has not changed.) I said no thanks to the Crestor and asked to be put back on Pravastatin. Nurse was really pushing back saying its still worth the risk because my cholesterol was too high on the Pravastin. I agreed to double my dose of it until we sort out this dispute. I get a call today from the cardiologist resident who was approached by the RN about my refusal to take Crestor. I get the same spiel about how its worth the risk. I explain patiently that A) I show no signs of heart disease. B)that my chest pain was very likely the hiatal hernia (which will be addressed separately)C) That although I understand their logic, I have worked very hard to keep my Diabetes controlled without Metformin. The common side effects of which (fecal incontinence and nausea) Ive seen with my sister and would very much like to avoid. Cardio Resident says she will "consult Endocrinology but they will likely say the same thing". Add to this that Im on Testosterone Cypionate , which she says can cause the triglycerides to read high. I told her to make sure she mentions this when she talks to the Endo. I feel like I am being forced onto a medication that I dont consent to. Here are my questions: 1) could Testosterone cypionate cause a false high reading of triglycerides on a blood test? 2) Am I being foolish in my refusal of the more aggressive statin? 3)Are there other options I am not seeing? | How high is your cholesterol? Since youre only 37 and they are pushing statins pretty hard, I would assume that your cholesterol sucks and you almost certainly should be on atorvastatin or rosuvastatin if it is being recommended by two cardiology providers. Small hiatal hernias do not generally cause chest pain, and for sure do not cause dizziness. If your chest pain was worse with exercise, its concerning for micro vascular disease, with a normal CT.Overall while statins do increase glucose intolerance, they overall have a net benefit in decreasing risk of heart attack and stroke. While your glucose numbers may change, its less about the glucose numbers and more about reducing downstream effects.It is kind of silly frankly to avoid metformin without knowing if youll have GI side effects or not. You likely will unfortunately need metformin in the future, statin or not, and if you dont tolerate metformin there are other alternatives out there such as GLP-1 agonists and SGLT-2 inhibitors that also help with cardiovascular risk. |
[
{
"from": "human",
"value": "Male 35 physically active no issues before non smokerRecently my entire body swelled up like edema was in the hospital CK level super high but leveled out and started attacking itself over the last year I've gone to every doctor possible. My body is losing skeletal muscle mass and spams for the last year with no clear answers. I'm swimming in all my clothes and no matter what I do nothing helps. Excessive exhaustion and sweating as well.Went to cardiologist but she was vague on my test and scheduled a ct was wondering if anyone had suggestions after echo and ekg were negativeI've been to go a rheumatologist, neurologist, etc and no one has answers for what's going onThis is the latest from my cardiologist but if anyone else has ideas pleaseRAC sign is present, suggestive of anomalous coronary circulation with retroaortic course."
},
{
"from": "gpt",
"value": "Wish you the best, really with this the only way anybody could provide any sort of advice would be a review of complete medical records and all lab findings"
}
] | Male 35 physically active no issues before non smokerRecently my entire body swelled up like edema was in the hospital CK level super high but leveled out and started attacking itself over the last year I've gone to every doctor possible. My body is losing skeletal muscle mass and spams for the last year with no clear answers. I'm swimming in all my clothes and no matter what I do nothing helps. Excessive exhaustion and sweating as well.Went to cardiologist but she was vague on my test and scheduled a ct was wondering if anyone had suggestions after echo and ekg were negativeI've been to go a rheumatologist, neurologist, etc and no one has answers for what's going onThis is the latest from my cardiologist but if anyone else has ideas pleaseRAC sign is present, suggestive of anomalous coronary circulation with retroaortic course. | Wish you the best, really with this the only way anybody could provide any sort of advice would be a review of complete medical records and all lab findings |
[
{
"from": "human",
"value": "Appreciate it al labs have come back completely negative only thing that's been consistently elevated but wasn't that much of a concern was CK levels everything else you could think of from any type of test normal"
},
{
"from": "gpt",
"value": "again, really need complete work up and medical notes to provide any insight here"
}
] | Appreciate it al labs have come back completely negative only thing that's been consistently elevated but wasn't that much of a concern was CK levels everything else you could think of from any type of test normal | again, really need complete work up and medical notes to provide any insight here |
[
{
"from": "human",
"value": "32F, 130-140lbs, have asthma and history of postpartum preeclampsia. Former cigarette smoker, currently vapes nicotine.ECG in comments.Ive been feeling huge thumps in my chest, several times a minute. Called 911 a few days ago because I wasnt sure if I was going to keel over, have never felt this before, and was scared. EMT thought I was in AFIB. ER doctor says no, just PVCs and to reduce my stress, stop vaping and limit caffeine. That these are harmless and I dont need to worry.Sometimes I feel lightly dizzy when it happens. I notice them when Im falling asleep. I notice them just sitting here, and the last few minutes, Ive been feeling big thumps pretty much every 15-20 seconds. Theres no way thats normal right?Can someone tell me if I need to ask my PCP for a referral to cardiology? Or tell me what youre seeing? This is truthfully scary to me and so uncomfortable."
},
{
"from": "gpt",
"value": "Normal sinus rhythm with a PVC. Not concerning."
}
] | 32F, 130-140lbs, have asthma and history of postpartum preeclampsia. Former cigarette smoker, currently vapes nicotine.ECG in comments.Ive been feeling huge thumps in my chest, several times a minute. Called 911 a few days ago because I wasnt sure if I was going to keel over, have never felt this before, and was scared. EMT thought I was in AFIB. ER doctor says no, just PVCs and to reduce my stress, stop vaping and limit caffeine. That these are harmless and I dont need to worry.Sometimes I feel lightly dizzy when it happens. I notice them when Im falling asleep. I notice them just sitting here, and the last few minutes, Ive been feeling big thumps pretty much every 15-20 seconds. Theres no way thats normal right?Can someone tell me if I need to ask my PCP for a referral to cardiology? Or tell me what youre seeing? This is truthfully scary to me and so uncomfortable. | Normal sinus rhythm with a PVC. Not concerning. |
[
{
"from": "human",
"value": "33F 144lb 55 ex-smoker x13yrs quit 2018 non-drinker Dx GPA with kidney/sinus/joint/skin involvement 2002, CKD2, chronic migraine with aura, SVT ablation 2017 dual AV node, sepsis 2018 from PID due to improperly placed IUD, dysautonomia (dx recently from tilt table test), Sjogrens, hospitalized in November for hypoglycaemia (glucose 2.7) still being worked up by endo but symptoms resolved after Rituxan so they are thinking autoimmune hypoglycaemia Im not going to list everything because its just depressing and not relevant. Basically a big mix of autoimmune disorders and premature degenerative conditions related to treatment for GPA Currently taking ..Rituxan infusions every 6 months, next one in a couple of weeksPlaquenilLipitorZoloftWellbutrinGabapentinCyclobenzabrineEltroxinVyvanseZopicloneDomperidoneZofranTopiramateOxycodoneTriptans for migrainesSome PRNs Im forgettingSo I just want to know if this ECG is normal. Ive never gotten any alerts for Afib on my Apple Watch before and today during a particularly brutal migraine with lots of dry heaving, I got a few alerts (this ecg isnt of the Afib ones). If you move the sensor, you can get different lead ECG readings (according to my cardiology nurse). I placed the sensor over V2 (I had to look that up) to get this reading and the big dip after the QRS complex (also had to look that up) looks off to me when I compare it to the normal image on Google. Is this something I should be concerned about? Migraine has started to abate but I feel weird. Heart was pounding in throat the whole time, especially when on my side. Some shortness of breath. Mostly feeling better now.Thanks for your time, help (hopefully) putting my mind at ease and teaching me something in the process :)Edit - also, not sure if relevant but I got my 5th COVID vaccine (the bivalent Pfizer one) on Mondayhttps://i.imgur.com/mA1T0Vz.jpg"
},
{
"from": "gpt",
"value": "EKG interpretation requires a very comprehensive understanding of cardiac electrophysiology, anatomy, and pathological processes, including the mechanisms that various arrhythmias, ischemia, and, in your particular case, previous procedures/ablations have on these functions. Without attempting to delve into the \"why's and how's\" of what these very complex squiggles mean, the short answer to your question is yes: inverted T waves in lead V2 can be completely normal in many individuals (that \"dip\" you're referring to after the QRS is the T-wave, and inverted just means that it's flipped upside down)."
}
] | 33F 144lb 55 ex-smoker x13yrs quit 2018 non-drinker Dx GPA with kidney/sinus/joint/skin involvement 2002, CKD2, chronic migraine with aura, SVT ablation 2017 dual AV node, sepsis 2018 from PID due to improperly placed IUD, dysautonomia (dx recently from tilt table test), Sjogrens, hospitalized in November for hypoglycaemia (glucose 2.7) still being worked up by endo but symptoms resolved after Rituxan so they are thinking autoimmune hypoglycaemia Im not going to list everything because its just depressing and not relevant. Basically a big mix of autoimmune disorders and premature degenerative conditions related to treatment for GPA Currently taking ..Rituxan infusions every 6 months, next one in a couple of weeksPlaquenilLipitorZoloftWellbutrinGabapentinCyclobenzabrineEltroxinVyvanseZopicloneDomperidoneZofranTopiramateOxycodoneTriptans for migrainesSome PRNs Im forgettingSo I just want to know if this ECG is normal. Ive never gotten any alerts for Afib on my Apple Watch before and today during a particularly brutal migraine with lots of dry heaving, I got a few alerts (this ecg isnt of the Afib ones). If you move the sensor, you can get different lead ECG readings (according to my cardiology nurse). I placed the sensor over V2 (I had to look that up) to get this reading and the big dip after the QRS complex (also had to look that up) looks off to me when I compare it to the normal image on Google. Is this something I should be concerned about? Migraine has started to abate but I feel weird. Heart was pounding in throat the whole time, especially when on my side. Some shortness of breath. Mostly feeling better now.Thanks for your time, help (hopefully) putting my mind at ease and teaching me something in the process :)Edit - also, not sure if relevant but I got my 5th COVID vaccine (the bivalent Pfizer one) on Mondayhttps://i.imgur.com/mA1T0Vz.jpg | EKG interpretation requires a very comprehensive understanding of cardiac electrophysiology, anatomy, and pathological processes, including the mechanisms that various arrhythmias, ischemia, and, in your particular case, previous procedures/ablations have on these functions. Without attempting to delve into the "why's and how's" of what these very complex squiggles mean, the short answer to your question is yes: inverted T waves in lead V2 can be completely normal in many individuals (that "dip" you're referring to after the QRS is the T-wave, and inverted just means that it's flipped upside down). |
[
{
"from": "human",
"value": "Thank you so much for the education :)"
},
{
"from": "gpt",
"value": "Did you place the back of the watch on your chest (in the V2 lead position) and then touch the crown with your finger to get this? If so, then the inverted T wave you are concerned about would not be a valid finding. The voltages in the precordial (V) leads in a 12 lead EKG are measured in relation to the average of the 4 limb leads, not just one arm which the watch is doing. EKG tracings from Apple Watches are good for determining heart rhythms but not much else."
}
] | Thank you so much for the education :) | Did you place the back of the watch on your chest (in the V2 lead position) and then touch the crown with your finger to get this? If so, then the inverted T wave you are concerned about would not be a valid finding. The voltages in the precordial (V) leads in a 12 lead EKG are measured in relation to the average of the 4 limb leads, not just one arm which the watch is doing. EKG tracings from Apple Watches are good for determining heart rhythms but not much else. |
[
{
"from": "human",
"value": "Thats exactly what I did. I was told you could use it on that area and even on the ankle to replicate different ECG (EKG?) leads. Thank you for the info!! Phew!"
},
{
"from": "gpt",
"value": "It would be theoretically possible to get a tracing with accurate wave morphology between 2 limbs with an Apple Watch, but it could be inverted if the polarity is switched. Please dont try this though, it can only serve to stress you out more. As long as the watch says sinus rhythm, you are probably good. Ask your physician for a standard EKG is you are concerned."
}
] | Thats exactly what I did. I was told you could use it on that area and even on the ankle to replicate different ECG (EKG?) leads. Thank you for the info!! Phew! | It would be theoretically possible to get a tracing with accurate wave morphology between 2 limbs with an Apple Watch, but it could be inverted if the polarity is switched. Please dont try this though, it can only serve to stress you out more. As long as the watch says sinus rhythm, you are probably good. Ask your physician for a standard EKG is you are concerned. |
[
{
"from": "human",
"value": "I appreciate you geeking out with me explaining the technology moreI find all of this stuff so fascinating. I got 6 Afib alerts today but I read there are a lot of false positives, especially with younger people. Will go get a full 12 lead to make sure. Thanks again!"
},
{
"from": "gpt",
"value": "Did the watch say an EKG tracing you performed showed afib or was it from monitoring from the heart rate sensor?"
}
] | I appreciate you geeking out with me explaining the technology moreI find all of this stuff so fascinating. I got 6 Afib alerts today but I read there are a lot of false positives, especially with younger people. Will go get a full 12 lead to make sure. Thanks again! | Did the watch say an EKG tracing you performed showed afib or was it from monitoring from the heart rate sensor? |
[
{
"from": "human",
"value": "An EKG I performed while having palpitations showed Afib, which is why I started trying to get different lead readings was trying to see if it was a fluke or not and get as much info for cardio if necessary (Holters suck). Didnt happen consistently when performing recordings back to backsome would say it detected Afib and others sinus."
},
{
"from": "gpt",
"value": "Thats a bit concerning. Be sure to show those EKG tracings to your cardiologist.Many of the medications you list can can affect heart rhythm and interact with each other. The Vyvanse particularly would not be good to take if there is a question of atrial fibrillation."
}
] | An EKG I performed while having palpitations showed Afib, which is why I started trying to get different lead readings was trying to see if it was a fluke or not and get as much info for cardio if necessary (Holters suck). Didnt happen consistently when performing recordings back to backsome would say it detected Afib and others sinus. | Thats a bit concerning. Be sure to show those EKG tracings to your cardiologist.Many of the medications you list can can affect heart rhythm and interact with each other. The Vyvanse particularly would not be good to take if there is a question of atrial fibrillation. |
[
{
"from": "human",
"value": "I think its long QT? Something QT? Pharmacist mentioned that I was on a lot that increased that risk so Ive been careful with the domperidone and zofran but I had to take both today. In your opinion, are there any meds you would cut? Other than the Oxycodone - I have a plan for that. I know you dont know my full medical history but I would love to eliminate some of these meds. Are there any redundant ones? Ones that work against another one? I wont take what you say as medical advice and discontinue meds or anything - just curious what another doctor would say. Appreciate it!Edit - and stopping Vyvanse for now until I talk to cardio is probably the best. I dont take it every day anyways"
},
{
"from": "gpt",
"value": "No way I can address something this complex and nuanced in this forum. Please discuss this with your personal physician."
}
] | I think its long QT? Something QT? Pharmacist mentioned that I was on a lot that increased that risk so Ive been careful with the domperidone and zofran but I had to take both today. In your opinion, are there any meds you would cut? Other than the Oxycodone - I have a plan for that. I know you dont know my full medical history but I would love to eliminate some of these meds. Are there any redundant ones? Ones that work against another one? I wont take what you say as medical advice and discontinue meds or anything - just curious what another doctor would say. Appreciate it!Edit - and stopping Vyvanse for now until I talk to cardio is probably the best. I dont take it every day anyways | No way I can address something this complex and nuanced in this forum. Please discuss this with your personal physician. |
[
{
"from": "human",
"value": "Thank you for the advice! We havent thought about pheochromocytoma. It does seem to line up. How does that get diagnosed? The website I was reading just a minute ago said a 24-hour urine test which she did when her GI doctor wanted to test for carcinoid syndrome/neuroendocrine tumors with a 5-HIAA urine test. I think they were only testing 5-HIAA though and not anything else so not sure if thats what they test for when checking for pheochromocytoma. Shes also had a kidney ultrasound and two abdominal (including kidneys) CT scans with contrast. Would they have shown up on those or is it one of those things they have to be specifically looking for?Shes reached out for therapy. She actually is a counselor herself so we tend to think she had the proper coping skills herself but as time has gone on with this, she has reached out to former colleagues, specifically to try to schedule EMDR therapy which has been very helpful for her in the past.The tricky part with it being related to anything COVID-related is she's never actually tested positive for COVID. So we don't know that she's had it even though when she searches for others dealing with her symptoms on reddit, it often takes her to posts in the covid longhaulers subreddit."
},
{
"from": "gpt",
"value": "5-HIAA testing is for carcinoid syndrome, not pheo"
}
] | Thank you for the advice! We havent thought about pheochromocytoma. It does seem to line up. How does that get diagnosed? The website I was reading just a minute ago said a 24-hour urine test which she did when her GI doctor wanted to test for carcinoid syndrome/neuroendocrine tumors with a 5-HIAA urine test. I think they were only testing 5-HIAA though and not anything else so not sure if thats what they test for when checking for pheochromocytoma. Shes also had a kidney ultrasound and two abdominal (including kidneys) CT scans with contrast. Would they have shown up on those or is it one of those things they have to be specifically looking for?Shes reached out for therapy. She actually is a counselor herself so we tend to think she had the proper coping skills herself but as time has gone on with this, she has reached out to former colleagues, specifically to try to schedule EMDR therapy which has been very helpful for her in the past.The tricky part with it being related to anything COVID-related is she's never actually tested positive for COVID. So we don't know that she's had it even though when she searches for others dealing with her symptoms on reddit, it often takes her to posts in the covid longhaulers subreddit. | 5-HIAA testing is for carcinoid syndrome, not pheo |
[
{
"from": "human",
"value": "I would test Seum Copper levels and Zinc. Copper deficiency can cause peripheral neuropathy, histamine intolerance (copper is a cofactor of DAO), dysautonomia (copper is a cofactor of DBH, required to convert dopamine to norepinephrine), EKG abnormalities.Copper deficiency can be caused by zinc toxicity, and zinc has become a very popular supplement \"to prevent\" COVID. Too much zinc supplementation without Copper can lead to copper deficiency.We havent looked into that. She doesnt take any zinc supplements so were not sure what would cause her to have copper deficiency or zinc toxicity. Well write it down to mention to her PCP at her next appointment.She has been checked for carcinoid syndrome. Her GI doctor suggested it and she had both the CgA blood test and 24-hour urine 5-HIAA test that luckily both came back in normal range."
},
{
"from": "gpt",
"value": "I agree with another poster - she needs to have a PCP that can consolidate her information and testing to help you guide where to go next. I think you keeping this list is fantastic to help you advocate for yourselves.There are a few things here:The white plaques found on the colonoscopy Spring 2021 is of very high interest especially given that the cause was not determined. Was it ever biopsied? It may be worth another repeat C-scope because it sounds like the most recent direct visualization was an EGD. Low grade colitis from inflammatory bowel disease doesnt always show up on a CT scan.I also think her autoimmune workup is incomplete from the blood work listed. In addition to this, viral illnesses (such as the one she had in 2019 that may or may not have been COVID) often can trigger the beginning of an autoimmune condition. The blood work ANA and RF is by no means comprehensive. Why was an RF checked? Was she having joint pain as well? With a family history, autoimmune conditions are very high on my listnose symptoms, lung symptoms, microscopic hematuria, peripheral nervous system issues beings up differentials including: GPA (granulomatosis with polyangitis previously known as Wegeners Granulomatosis) and Anti-GBM (Goodpasture) Disease which are autoimmune vasculitisI would recommend checking for vasculitis: ESR, CRP, C3/4, ANCA, Anti-GBM, cryoglobulinsOther autoimmune conditions can manifest with GI issues too - there is a lot of overlap. Whether she has joint pain or not, I would check CCP, HLA B27, Sjogren panelSystemic scleroderma is a possibility too which would include Anti-Scl70 labsIf she has joint pain, a synovial ultrasound of the hands / feet may find active joint or tendon inflammation which would support an inflammatory condition as well.I hope this information can help bring your wife some answers and hopefully treatment"
}
] | I would test Seum Copper levels and Zinc. Copper deficiency can cause peripheral neuropathy, histamine intolerance (copper is a cofactor of DAO), dysautonomia (copper is a cofactor of DBH, required to convert dopamine to norepinephrine), EKG abnormalities.Copper deficiency can be caused by zinc toxicity, and zinc has become a very popular supplement "to prevent" COVID. Too much zinc supplementation without Copper can lead to copper deficiency.We havent looked into that. She doesnt take any zinc supplements so were not sure what would cause her to have copper deficiency or zinc toxicity. Well write it down to mention to her PCP at her next appointment.She has been checked for carcinoid syndrome. Her GI doctor suggested it and she had both the CgA blood test and 24-hour urine 5-HIAA test that luckily both came back in normal range. | I agree with another poster - she needs to have a PCP that can consolidate her information and testing to help you guide where to go next. I think you keeping this list is fantastic to help you advocate for yourselves.There are a few things here:The white plaques found on the colonoscopy Spring 2021 is of very high interest especially given that the cause was not determined. Was it ever biopsied? It may be worth another repeat C-scope because it sounds like the most recent direct visualization was an EGD. Low grade colitis from inflammatory bowel disease doesnt always show up on a CT scan.I also think her autoimmune workup is incomplete from the blood work listed. In addition to this, viral illnesses (such as the one she had in 2019 that may or may not have been COVID) often can trigger the beginning of an autoimmune condition. The blood work ANA and RF is by no means comprehensive. Why was an RF checked? Was she having joint pain as well? With a family history, autoimmune conditions are very high on my listnose symptoms, lung symptoms, microscopic hematuria, peripheral nervous system issues beings up differentials including: GPA (granulomatosis with polyangitis previously known as Wegeners Granulomatosis) and Anti-GBM (Goodpasture) Disease which are autoimmune vasculitisI would recommend checking for vasculitis: ESR, CRP, C3/4, ANCA, Anti-GBM, cryoglobulinsOther autoimmune conditions can manifest with GI issues too - there is a lot of overlap. Whether she has joint pain or not, I would check CCP, HLA B27, Sjogren panelSystemic scleroderma is a possibility too which would include Anti-Scl70 labsIf she has joint pain, a synovial ultrasound of the hands / feet may find active joint or tendon inflammation which would support an inflammatory condition as well.I hope this information can help bring your wife some answers and hopefully treatment |
[
{
"from": "human",
"value": "I greatly appreciate this response as its extremely informative!The white plaques were never followed up on unfortunately. Her blood in her stool cleared up shortly after so she let it go.I definitely agree with you on the autoimmune thoughts. I had no idea there were so much more to test for. What kind of specialist would she see who would run those kinds of tests and how does she approach it with that doctor? Just tell them she wants to be tested for everything?"
},
{
"from": "gpt",
"value": "A lot of those blood tests I mentioned any primary can order as well as the synovial ultrasound.Its hard to approach an MD about specific tests but I think its worth asking. It just depends on how you think your doctor is. I have patients ask me for specific tests pretty often and we just make a joint decision on if its worth it in shared decision making.As for which specialty? rheumatology and GI would be the ones in my opinion."
}
] | I greatly appreciate this response as its extremely informative!The white plaques were never followed up on unfortunately. Her blood in her stool cleared up shortly after so she let it go.I definitely agree with you on the autoimmune thoughts. I had no idea there were so much more to test for. What kind of specialist would she see who would run those kinds of tests and how does she approach it with that doctor? Just tell them she wants to be tested for everything? | A lot of those blood tests I mentioned any primary can order as well as the synovial ultrasound.Its hard to approach an MD about specific tests but I think its worth asking. It just depends on how you think your doctor is. I have patients ask me for specific tests pretty often and we just make a joint decision on if its worth it in shared decision making.As for which specialty? rheumatology and GI would be the ones in my opinion. |
[
{
"from": "human",
"value": "Hey. I am male 24 Height 5:10 and weigh 87 kg. I don't drink or smoke. For a few months i have been suffering from left sided chest pain that radiates to my left arm and back. I also suffer from shortness of breath at times. I decided to get my lipid profile done and my cholesterol levels came back very high. I then decided to get Echo Cardiogram and Exercise Tolerance Test and some other blood work. Can you take a look at my reports. Thankshttps://imgur.com/a/SiBOG1Phttps://imgur.com/a/yKBhqsFhttps://imgur.com/a/aK6RuWchttps://imgur.com/a/IWwMi1vhttps://imgur.com/a/UaEOvP2"
},
{
"from": "gpt",
"value": "The point of getting testing like this done is to go over it with a medical professional who can then make recommendations. The echo and stress test are normal, your cholesterol is too high. I'd suggest that you find a primary care doctor."
}
] | Hey. I am male 24 Height 5:10 and weigh 87 kg. I don't drink or smoke. For a few months i have been suffering from left sided chest pain that radiates to my left arm and back. I also suffer from shortness of breath at times. I decided to get my lipid profile done and my cholesterol levels came back very high. I then decided to get Echo Cardiogram and Exercise Tolerance Test and some other blood work. Can you take a look at my reports. Thankshttps://imgur.com/a/SiBOG1Phttps://imgur.com/a/yKBhqsFhttps://imgur.com/a/aK6RuWchttps://imgur.com/a/IWwMi1vhttps://imgur.com/a/UaEOvP2 | The point of getting testing like this done is to go over it with a medical professional who can then make recommendations. The echo and stress test are normal, your cholesterol is too high. I'd suggest that you find a primary care doctor. |
[
{
"from": "human",
"value": "I did. Was recommended to start statins but i am yet to start those. I wan't to see if the levels could be brought down by lifestyle and diet changes first. I just can't figure out why im experiencing the chest pain."
},
{
"from": "gpt",
"value": "That's a good thing to talk to your PCP about. GERD is a common cause of non-cardiac chest pain."
}
] | I did. Was recommended to start statins but i am yet to start those. I wan't to see if the levels could be brought down by lifestyle and diet changes first. I just can't figure out why im experiencing the chest pain. | That's a good thing to talk to your PCP about. GERD is a common cause of non-cardiac chest pain. |
[
{
"from": "human",
"value": "35 yo female 5'7\" (170 cm) 180lbs (81.6kg) Caucasian and Native American I have previously had high blood pressure, but as of the last year or so my blood pressure has become very LOW for undetermined reasons, with my most recent reading being 101/60Primary symptoms: Decreasing general health for the past ~3 years, primarily presenting as severe fatigue, syncope + nausea when overheated or standing up too quickly, needing a minimum of 10-12 hours of sleep every night to feel rested, general malaise.I have asthma, ADD, MDD. Drink occasionally; previous occasional smoker but quit ~5 years ago. Same for recreational drugs -- on occasion when I was younger, but none for at least 5 years. I had previously been diagnosed with Rheumatic Fever in 2015, which seems VERY relevant here, but every doctor I've tried to discuss it with brushes it off when I mention it.So, last month I finally got a referral to a cardiologist, after years of trying to get one, and I was given a heart monitor to wear at home for two weeks, and then on Dec 23rd I had an echocardiogram ultrasound done. After trying and failing to get ahold of them by phone, Friday I FINALLY received a letter in the mail with my results. The front page of that letter states that all my tests were normal, and no follow-up is needed.THEN, that same letter goes on to detail in the next few pages that I have a small left ventricle, sinus tachycardia with an average heartbeat ranging from 90-150 bpm, paradoxical septal motion, mild pulmonary valve regurgitation, a thickened mitral valve, mild mitral valve regurgitation, trivial tricuspid valve regurgitation, and then it states that my \"right ventricular systolic pressure could not be estimated due to inability to detect peak tricuspid regurgitation\" and that my pulmonary valve stats were also inconclusive due to \"poor visualization\".The \"inconclusives\" I suppose could go either way, and I don't know if those are something I should try to get more testing for to clear up or not. But the rest definitely does not sound \"normal\" to me, and based on a quick Google search most of those things seem to be more common in someone who has had previous cardiac surgery, which I have not, and/or they usually go hand-in-hand with severe pulmonary hypertension, and as previously mentioned, my blood pressure has been consistently LOW, to the point of being almost abnormally so, for at least the past year.So, is there anyone who can confirm that all those abnormalities could be found, while still falling within the \"normal\" range of test results? Am I just reading too much into this, or am I right in thinking that my cardiologist didn't do his job properly, and a second opinion is needed?Update: Wow this really took off way more than I expected! I went to bed early last night, was busy with other stuff this morning, and then I'm American, so I have been thoroughly distracted by the absolute shitshow going on in DC ever since..., so I haven't logged on to Reddit to check back on responses until just now. Thank you to everyone for what looks like some very educated replies; I'm working my way through them and will try to respond more thoroughly tomorrow after a good night's (hopefully) sleep!"
},
{
"from": "gpt",
"value": "Nearly all of the things youve described are seen on essentially every echo report. Trivial and trace and mild regurgitation are seen in one or more valves of (what I estimate to be) the vast majority of healthy people. The regurgitation is only really abnormal if its significant (moderate or severe). Its important to mention any at all, though, so the previous report can be compared to any future ones (among other reasons). The reason theres a lot of could not assess...poor visualization all over the report is because this was a transthoracic echo. If they need better visualization of those structures, they would need to do a transesophageal echo which is a really not-fun procedure which requires you to be sedated, and is usually reserved for people with high suspicion for infective endocarditis or severe cardiac disease involving the poorly visualized structures.The rest of the findings could be related to pulmonary arterial HTN, which youve already mentioned. PAH is not the same as hypertension in general. The lung circulation is separate from the systemic circulation (though obviously the two are connected) and PAH is usually due to changes in the lung structure or function. For example, COPD, pulmonary fibrosis (scarring in the lungs), or - my attendings personal favorite underdog in the world of heart/lung issues - sleep apnea.The full report of any diagnostic study, like an echo, is always going to have something that doesnt sound completely normal in it - the wonderful world of incidental findings. Thats why its important to go by what the cardiologist or other ordering physician interprets from the echo. Its also why every diagnostic report has a disclaimer along the lines of correlate with clinical findings. In the context of your presentation, the echo that you had done was essentially normal. Its what my own echo report said despite results that could have been used to diagnose someone with heart failure with reduced ejection fraction had they been a 68 year old with blood pressure of 155/100 for the past 25 years, extra heart sounds, and shortness of breath.Your echo was done, I presume, to look for rheumatic heart disease in the context of your clinical findings (which could be consistent with that, though its rare to get this from only having rheumatic fever once). These findings arent really consistent with RHD. The mitral valve is slightly thickened, which may be the result of the rheumatic fever, but the report does not show mitral stenosis (the expected consequence of RHD).What Id recommend doing is writing down the findings youve seen on the report, including your concerns about what they could mean, and other good questions youve asked in your post here (like about pulmonary artery hypertension, and the poor visualization of certain structures on the echo and how important these inconclusive findings would be to a diagnosis) and take them with you to the next appointment. Because your cardiologist has a more complete picture of your clinical presentation and other health info, they are the best person to help guide you through the report, why they do not feel this echo has shown the underlying problem, and the next steps to take.Best of luck to you, and thank you for the question! Echo reports are always confusing and concerning to many who arent aware that many of the abnormal findings are often normal variants, so this is a great post to discuss that with."
}
] | 35 yo female 5'7" (170 cm) 180lbs (81.6kg) Caucasian and Native American I have previously had high blood pressure, but as of the last year or so my blood pressure has become very LOW for undetermined reasons, with my most recent reading being 101/60Primary symptoms: Decreasing general health for the past ~3 years, primarily presenting as severe fatigue, syncope + nausea when overheated or standing up too quickly, needing a minimum of 10-12 hours of sleep every night to feel rested, general malaise.I have asthma, ADD, MDD. Drink occasionally; previous occasional smoker but quit ~5 years ago. Same for recreational drugs -- on occasion when I was younger, but none for at least 5 years. I had previously been diagnosed with Rheumatic Fever in 2015, which seems VERY relevant here, but every doctor I've tried to discuss it with brushes it off when I mention it.So, last month I finally got a referral to a cardiologist, after years of trying to get one, and I was given a heart monitor to wear at home for two weeks, and then on Dec 23rd I had an echocardiogram ultrasound done. After trying and failing to get ahold of them by phone, Friday I FINALLY received a letter in the mail with my results. The front page of that letter states that all my tests were normal, and no follow-up is needed.THEN, that same letter goes on to detail in the next few pages that I have a small left ventricle, sinus tachycardia with an average heartbeat ranging from 90-150 bpm, paradoxical septal motion, mild pulmonary valve regurgitation, a thickened mitral valve, mild mitral valve regurgitation, trivial tricuspid valve regurgitation, and then it states that my "right ventricular systolic pressure could not be estimated due to inability to detect peak tricuspid regurgitation" and that my pulmonary valve stats were also inconclusive due to "poor visualization".The "inconclusives" I suppose could go either way, and I don't know if those are something I should try to get more testing for to clear up or not. But the rest definitely does not sound "normal" to me, and based on a quick Google search most of those things seem to be more common in someone who has had previous cardiac surgery, which I have not, and/or they usually go hand-in-hand with severe pulmonary hypertension, and as previously mentioned, my blood pressure has been consistently LOW, to the point of being almost abnormally so, for at least the past year.So, is there anyone who can confirm that all those abnormalities could be found, while still falling within the "normal" range of test results? Am I just reading too much into this, or am I right in thinking that my cardiologist didn't do his job properly, and a second opinion is needed?Update: Wow this really took off way more than I expected! I went to bed early last night, was busy with other stuff this morning, and then I'm American, so I have been thoroughly distracted by the absolute shitshow going on in DC ever since..., so I haven't logged on to Reddit to check back on responses until just now. Thank you to everyone for what looks like some very educated replies; I'm working my way through them and will try to respond more thoroughly tomorrow after a good night's (hopefully) sleep! | Nearly all of the things youve described are seen on essentially every echo report. Trivial and trace and mild regurgitation are seen in one or more valves of (what I estimate to be) the vast majority of healthy people. The regurgitation is only really abnormal if its significant (moderate or severe). Its important to mention any at all, though, so the previous report can be compared to any future ones (among other reasons). The reason theres a lot of could not assess...poor visualization all over the report is because this was a transthoracic echo. If they need better visualization of those structures, they would need to do a transesophageal echo which is a really not-fun procedure which requires you to be sedated, and is usually reserved for people with high suspicion for infective endocarditis or severe cardiac disease involving the poorly visualized structures.The rest of the findings could be related to pulmonary arterial HTN, which youve already mentioned. PAH is not the same as hypertension in general. The lung circulation is separate from the systemic circulation (though obviously the two are connected) and PAH is usually due to changes in the lung structure or function. For example, COPD, pulmonary fibrosis (scarring in the lungs), or - my attendings personal favorite underdog in the world of heart/lung issues - sleep apnea.The full report of any diagnostic study, like an echo, is always going to have something that doesnt sound completely normal in it - the wonderful world of incidental findings. Thats why its important to go by what the cardiologist or other ordering physician interprets from the echo. Its also why every diagnostic report has a disclaimer along the lines of correlate with clinical findings. In the context of your presentation, the echo that you had done was essentially normal. Its what my own echo report said despite results that could have been used to diagnose someone with heart failure with reduced ejection fraction had they been a 68 year old with blood pressure of 155/100 for the past 25 years, extra heart sounds, and shortness of breath.Your echo was done, I presume, to look for rheumatic heart disease in the context of your clinical findings (which could be consistent with that, though its rare to get this from only having rheumatic fever once). These findings arent really consistent with RHD. The mitral valve is slightly thickened, which may be the result of the rheumatic fever, but the report does not show mitral stenosis (the expected consequence of RHD).What Id recommend doing is writing down the findings youve seen on the report, including your concerns about what they could mean, and other good questions youve asked in your post here (like about pulmonary artery hypertension, and the poor visualization of certain structures on the echo and how important these inconclusive findings would be to a diagnosis) and take them with you to the next appointment. Because your cardiologist has a more complete picture of your clinical presentation and other health info, they are the best person to help guide you through the report, why they do not feel this echo has shown the underlying problem, and the next steps to take.Best of luck to you, and thank you for the question! Echo reports are always confusing and concerning to many who arent aware that many of the abnormal findings are often normal variants, so this is a great post to discuss that with. |
[
{
"from": "human",
"value": "Sorry for such a late reply, but the past few days have been a bit busy for me. Thank you for such a detailed response!So, the echo actually wasn't done specifically to look for Rheumatic heart disease -- that's just something I thought might be relevant or related to the problems I've been having. It was primarily done because I've been having these periodic attacks of such severe fatigue I can barely get out of bed, and when I do manage to get myself upright, I get out of breath and heart-poundy with even the slightest exertion, and am just generally extremely weak and disoriented -- I can't lift my arm over my head for more than a couple seconds, can't stay standing very long without sitting or leaning heavily on something, etc... and if I try to fight it and actually KEEP myself upright and moving around for more than a minute or two -- ie, to take a shower -- it quickly progresses to my heart feeling like it's gonna pound out of my chest, then nausea + room violently spinning, very rapidly followed by syncope. I'm not sure if it's full or partial syncope because I'm not sure if only being \"out\" for a few seconds or so qualifies as full syncope or just partial -- but I definitely black out briefly and collapse, and then spend awhile feeling violently sick and dizzy and shaky (and cold-sweaty) after I come back to. These \"attacks\" (episodes? Not really sure what to call them) come and go, but when they happen, they generally last about a week (roughly 3-4 days of being really bad, then another 3-4 days of recovery before I'm relatively back to normal again.) I've figured out that my Adderall prescription seemed to be a primary trigger for these attacks, so I've recently quit taking that altogether, and I'm hoping that will drastically reduce the attacks... but they've definitely happened at other times even without any triggers that I've been able to pinpoint, so it's not the Adderall that was CAUSING it (also it didn't happen every time I took the Adderall, which is why it took awhile to pinpoint that being a huge trigger) -- there's something underlying that's going on, and the Adderall just seemed to trigger whatever that \"something\" is. But I'm not sure what it is that triggers them other times.So, my cardiology workup was primarily to try to figure out what the hell is going on with me as far as all that. I was honestly really hoping the answers here would be along the lines of \"yes, something DEFINITELY got overlooked or mixed up, you need to call and insist on a follow-up appointment and let your doctor know he effed up and x, y, and z needs to be immediately looked into further\". I mean I'm not looking for a malpractice suit or anything, I understand mistakes can happen... but I just really wanted to hear that it WAS a mistake, because I'm SO. FED. UP. with these goddamn symptoms.I have been in and out of doctor appointments CONSTANTLY for three years now. And I haven't been able to work for those three years because jobs just fire me for having to call in too often. And despite three years of endless appointments and efforts, I feel like I'm still no closer to having any answers... so I was REALLY hoping this would finally provide some. I would rather have an upsetting diagnosis at this point, than continue having NO diagnosis at all. Knowing what IS wrong would be so much more useful than just knowing one more thing that isn't -- once I know what IS wrong, I can actually get a treatment plan going for it, and maybe I can finally start getting my life back on track. I used to be super active -- worked full-time in a restaurant, on my feet running around 40 hours a week; spent my free time riding bikes, hiking, and gardening, as much as possible... and now I can barely do any of that. Very short hikes, small amounts of gardening... but none of the rest. I want my life back.Or worst case scenario, with a diagnosis I could at least apply for disability, if getting my life back isn't an option, and have some meager bit of income again, anyway. I could start processing the fact that getting my life back close to where it was before just isn't gonna happen, and deal with that, instead of holding out some hope of being able to be \"fixed\" -- at least somewhat -- once I finally know what's wrong. With answers, I could at least do SOMETHING. With no answers, my life just stays in this shitty limbo indefinitely. And I really, really thought this was going to be what finally gave me some answers. It 100% FEELS like it's my heart that's the root of my problems... and I was even about 2/3rds through one of the attack weeks when I had the echo done, so I thought for sure it would show something while I was right in the midst of it, especially. So I just can't wrap my head around how everything could be \"basically normal.\"I suppose that all wasn't exactly clear in my \"symptoms\" summary -- I was just trying to rush through and get to the echo results, and didn't really feel like typing out the whole story -- so I just figured \"fatigue/syncope/malaise\" would cover the gist of it.I do really appreciate your response, though... I just wish it was what I actually wanted to hear. I just don't know how much more I can take of hearing \"nothing seems to be wrong\" when something is so obviously, seriously wrong. I know it's not psychosomatic; any doctor who tried to tell me it's \"anxiety and/or depression\" would probably find themself in possession of a brand new, shiny, second asshole by the time I was done with them... but this never-ending lack of answers does sometimes make me wonder if I'm going crazy. It feels like I'm being gaslit -- but by medical science, not by a person."
},
{
"from": "gpt",
"value": "Hello. I'm not a native English speaker so the terms \"mild\" or \"moderate\" got me a little confused at first. The medical student and the cardiologist gave a very good explanation as to why those are really normal findings, those are normal findings in my country as well. Still heart rate isn't normal, and symptoms persist so there is still a problem. Now we now it isn't in the heart. I also think that the rheumatoid fever isn't something to be worried of there was only one event, the echocardiogram findings demonstrate mitral valve thicken but not an stenosis, I agree with the rest and think that is not a problem. There are not-doctors that are thinking about POTS/dysautonomy, I came here to tell them they are not crazy, I also suspect that. However dysautonomy is diagnosed by discarding other illnesses, and with only the findings of an echocardiogram it cannot be diagnosed. I would ask with internal medicine for a second opinion and more tests, first you have to discard hypothyroidism (not likely), adrenal dysfunction and endocrine dysfunctions. The recommendations to better your symptoms are drinking more water, change positions slowly: if you are in crouch position stand up as slowly as you can, from laying down sit before you stand up. Try doing some non impact exercise (not a good idea: weight lifting, running, crossfit). Hope you get better and find some answers. Stay safe"
}
] | Sorry for such a late reply, but the past few days have been a bit busy for me. Thank you for such a detailed response!So, the echo actually wasn't done specifically to look for Rheumatic heart disease -- that's just something I thought might be relevant or related to the problems I've been having. It was primarily done because I've been having these periodic attacks of such severe fatigue I can barely get out of bed, and when I do manage to get myself upright, I get out of breath and heart-poundy with even the slightest exertion, and am just generally extremely weak and disoriented -- I can't lift my arm over my head for more than a couple seconds, can't stay standing very long without sitting or leaning heavily on something, etc... and if I try to fight it and actually KEEP myself upright and moving around for more than a minute or two -- ie, to take a shower -- it quickly progresses to my heart feeling like it's gonna pound out of my chest, then nausea + room violently spinning, very rapidly followed by syncope. I'm not sure if it's full or partial syncope because I'm not sure if only being "out" for a few seconds or so qualifies as full syncope or just partial -- but I definitely black out briefly and collapse, and then spend awhile feeling violently sick and dizzy and shaky (and cold-sweaty) after I come back to. These "attacks" (episodes? Not really sure what to call them) come and go, but when they happen, they generally last about a week (roughly 3-4 days of being really bad, then another 3-4 days of recovery before I'm relatively back to normal again.) I've figured out that my Adderall prescription seemed to be a primary trigger for these attacks, so I've recently quit taking that altogether, and I'm hoping that will drastically reduce the attacks... but they've definitely happened at other times even without any triggers that I've been able to pinpoint, so it's not the Adderall that was CAUSING it (also it didn't happen every time I took the Adderall, which is why it took awhile to pinpoint that being a huge trigger) -- there's something underlying that's going on, and the Adderall just seemed to trigger whatever that "something" is. But I'm not sure what it is that triggers them other times.So, my cardiology workup was primarily to try to figure out what the hell is going on with me as far as all that. I was honestly really hoping the answers here would be along the lines of "yes, something DEFINITELY got overlooked or mixed up, you need to call and insist on a follow-up appointment and let your doctor know he effed up and x, y, and z needs to be immediately looked into further". I mean I'm not looking for a malpractice suit or anything, I understand mistakes can happen... but I just really wanted to hear that it WAS a mistake, because I'm SO. FED. UP. with these goddamn symptoms.I have been in and out of doctor appointments CONSTANTLY for three years now. And I haven't been able to work for those three years because jobs just fire me for having to call in too often. And despite three years of endless appointments and efforts, I feel like I'm still no closer to having any answers... so I was REALLY hoping this would finally provide some. I would rather have an upsetting diagnosis at this point, than continue having NO diagnosis at all. Knowing what IS wrong would be so much more useful than just knowing one more thing that isn't -- once I know what IS wrong, I can actually get a treatment plan going for it, and maybe I can finally start getting my life back on track. I used to be super active -- worked full-time in a restaurant, on my feet running around 40 hours a week; spent my free time riding bikes, hiking, and gardening, as much as possible... and now I can barely do any of that. Very short hikes, small amounts of gardening... but none of the rest. I want my life back.Or worst case scenario, with a diagnosis I could at least apply for disability, if getting my life back isn't an option, and have some meager bit of income again, anyway. I could start processing the fact that getting my life back close to where it was before just isn't gonna happen, and deal with that, instead of holding out some hope of being able to be "fixed" -- at least somewhat -- once I finally know what's wrong. With answers, I could at least do SOMETHING. With no answers, my life just stays in this shitty limbo indefinitely. And I really, really thought this was going to be what finally gave me some answers. It 100% FEELS like it's my heart that's the root of my problems... and I was even about 2/3rds through one of the attack weeks when I had the echo done, so I thought for sure it would show something while I was right in the midst of it, especially. So I just can't wrap my head around how everything could be "basically normal."I suppose that all wasn't exactly clear in my "symptoms" summary -- I was just trying to rush through and get to the echo results, and didn't really feel like typing out the whole story -- so I just figured "fatigue/syncope/malaise" would cover the gist of it.I do really appreciate your response, though... I just wish it was what I actually wanted to hear. I just don't know how much more I can take of hearing "nothing seems to be wrong" when something is so obviously, seriously wrong. I know it's not psychosomatic; any doctor who tried to tell me it's "anxiety and/or depression" would probably find themself in possession of a brand new, shiny, second asshole by the time I was done with them... but this never-ending lack of answers does sometimes make me wonder if I'm going crazy. It feels like I'm being gaslit -- but by medical science, not by a person. | Hello. I'm not a native English speaker so the terms "mild" or "moderate" got me a little confused at first. The medical student and the cardiologist gave a very good explanation as to why those are really normal findings, those are normal findings in my country as well. Still heart rate isn't normal, and symptoms persist so there is still a problem. Now we now it isn't in the heart. I also think that the rheumatoid fever isn't something to be worried of there was only one event, the echocardiogram findings demonstrate mitral valve thicken but not an stenosis, I agree with the rest and think that is not a problem. There are not-doctors that are thinking about POTS/dysautonomy, I came here to tell them they are not crazy, I also suspect that. However dysautonomy is diagnosed by discarding other illnesses, and with only the findings of an echocardiogram it cannot be diagnosed. I would ask with internal medicine for a second opinion and more tests, first you have to discard hypothyroidism (not likely), adrenal dysfunction and endocrine dysfunctions. The recommendations to better your symptoms are drinking more water, change positions slowly: if you are in crouch position stand up as slowly as you can, from laying down sit before you stand up. Try doing some non impact exercise (not a good idea: weight lifting, running, crossfit). Hope you get better and find some answers. Stay safe |
[
{
"from": "human",
"value": "48 year old female 54 normal weight female. Went to the ER for chest pains on the left side that were consistent for about two months and have since subsided in the ER had a normal chest CAT scan with contrast. Low anion Gap. I was just looking back at bloodwork from ER visit in December and noticed Anion Gap was 1/mol/L but Albumin was normal 3.9 and total protein normal 7.2. The Dr didn't mention this to me. And just saw this now. So worried about Multiple Myeloma now. My sodium was low 131 and SGPT (ALT) was low 12. The only thing they mentioned was elevated Hgb 15.5 and Het 46.3% but said nothing to worry about. Can anyone give their opinion. Ive also been to the gastroenterologist and cardiologist, upper endoscopy and colonoscopy normal and all cardiology tests were clear just showed some palpitations upon exertion."
},
{
"from": "gpt",
"value": "Multiple myeloma usually has high calcium, kidney disease, anemia (low blood count) and bone disease. You mentioned none of those. Low anion gap is hardly used in the emergency setting, and usually will need retesting if blood to see if it was a one time occurrence."
}
] | 48 year old female 54 normal weight female. Went to the ER for chest pains on the left side that were consistent for about two months and have since subsided in the ER had a normal chest CAT scan with contrast. Low anion Gap. I was just looking back at bloodwork from ER visit in December and noticed Anion Gap was 1/mol/L but Albumin was normal 3.9 and total protein normal 7.2. The Dr didn't mention this to me. And just saw this now. So worried about Multiple Myeloma now. My sodium was low 131 and SGPT (ALT) was low 12. The only thing they mentioned was elevated Hgb 15.5 and Het 46.3% but said nothing to worry about. Can anyone give their opinion. Ive also been to the gastroenterologist and cardiologist, upper endoscopy and colonoscopy normal and all cardiology tests were clear just showed some palpitations upon exertion. | Multiple myeloma usually has high calcium, kidney disease, anemia (low blood count) and bone disease. You mentioned none of those. Low anion gap is hardly used in the emergency setting, and usually will need retesting if blood to see if it was a one time occurrence. |
[
{
"from": "human",
"value": "Thank you for the response. Several months ago I did have elevated calcium but have been retested two times and calcium was normal. I was taking a lot of gas x and alka seltzer for the chest pain that I had gone in for.Also had bloodwork three weeks prior and anion gap and albumin and globulin were normal. Would that change so fast?"
},
{
"from": "gpt",
"value": "Anion gap is calculated by (sodium + potassium) - (bicarbonate and chloride). Most of the time when it is reported as low it is because there is slight variation in these factors from any random blood sample leading it to be falsely low. This is why they usually repeat it, and usually it normalizes."
}
] | Thank you for the response. Several months ago I did have elevated calcium but have been retested two times and calcium was normal. I was taking a lot of gas x and alka seltzer for the chest pain that I had gone in for.Also had bloodwork three weeks prior and anion gap and albumin and globulin were normal. Would that change so fast? | Anion gap is calculated by (sodium + potassium) - (bicarbonate and chloride). Most of the time when it is reported as low it is because there is slight variation in these factors from any random blood sample leading it to be falsely low. This is why they usually repeat it, and usually it normalizes. |
[
{
"from": "human",
"value": "8F, 78lbs, no medication. She was in the hospital for a long time but they discharged her. She is still in pain, please help. I attached the notes of her discharge.The patient is an 8-year-old white female with five weeks of fever, rash, arthralgias. Last month, the patient noted foot pain involving both left and right feet, as well as a blotchy pink rash on the leg that proceeded to spread to the trunk and then arms and then face during that week. The patient had low-grade fevers with temps to a max of 101. This has progressed to the week prior to admission higher fevers with T-max of 103.5. The patient has endorsed muscle pain, particularly in the right leg and arm, and PMD had seen the patient this week noted right knee and right index finger swelling. There is no noted weight change over this time period. No noted diarrhea or swollen nodes. The rash the patient described the week prior had an acute abrupt onset and 5-10 minutes later would dissipate.Rheumatology was consulted on the patient from admission. Lab studies were sent to rule-out an infectious etiology for rash. Strep culture was negative. EKG was also performed to rule-out a prolonged PR interval. EKG was within normal limits. A DNase B antibody was 547 and an ASO titer was 300. While results were elevated, the patient did no meet clinical criteria for rheumatic fever and diagnosis that was most likely entertained was systemic JIA. Further lab work included an ANA which was negative, rheumatoid factor which was negative, a CRP on admission was 8.6 mg/dL with an ESR about 80. CK and aldolase were within normal limits. Ferritin was elevated at 663. LDH was within normal limits. CBC was reassuring with normal white counts, hemoglobin and platelets; findings nonsuggestive of leukemia. Hepatic panel within normal limits. A chest x-ray was done to rule-out mediastinal mass, and that was negative. From an infectious standpoint, Parvo, CMV, EBV were all negative. Clinically the patient was noted to have a salmon-colored transient rash that would come and go throughout the hospitalization lasting a matter of minutes. No definite arthritis on examination. Oncology was consulted given the history of arthritis and fevers. It was felt in the setting of normal cell lines in evaluating a smear, which revealed no blasts, no indication of hepatomegaly or splenomegaly and uric acid and LDH within normal limits and x-ray that was normal, they felt that further oncologic evaluation was not indicated and a bone marrow was not indicated at that time. Cardiology was also officially consulted because the patient had a 2/6 ejection murmur on the exam. Cardiology felt the murmur was a flow murmur and evaluated the EKG, which they read as within normal limits, and decided an echo was not indicated to rule-out valvular disease in the setting of the rash and arthritis in an attempt to workup acute rheumatic fever."
},
{
"from": "gpt",
"value": "Internal medicine doc here but in my differential is Adult Onset Stills Disease which can still present in children and Rocky Mountain Spotted Fever. The salmon colored rash lasting a few minutes is textbook for Adult Onset Stills Disease.I'm assuming she had blood cultures done at one or multiple points during her admission. Did she have a procalcitonin tested? Did she receive any antibiotics? Any steroids like solumedrol, prednisone etc? Does she still have joint pain? Does this rash show up only during febrile episodes? Any auto immune conditions in the family like lupus, rheumatoid arthritis, hashimotos?"
}
] | 8F, 78lbs, no medication. She was in the hospital for a long time but they discharged her. She is still in pain, please help. I attached the notes of her discharge.The patient is an 8-year-old white female with five weeks of fever, rash, arthralgias. Last month, the patient noted foot pain involving both left and right feet, as well as a blotchy pink rash on the leg that proceeded to spread to the trunk and then arms and then face during that week. The patient had low-grade fevers with temps to a max of 101. This has progressed to the week prior to admission higher fevers with T-max of 103.5. The patient has endorsed muscle pain, particularly in the right leg and arm, and PMD had seen the patient this week noted right knee and right index finger swelling. There is no noted weight change over this time period. No noted diarrhea or swollen nodes. The rash the patient described the week prior had an acute abrupt onset and 5-10 minutes later would dissipate.Rheumatology was consulted on the patient from admission. Lab studies were sent to rule-out an infectious etiology for rash. Strep culture was negative. EKG was also performed to rule-out a prolonged PR interval. EKG was within normal limits. A DNase B antibody was 547 and an ASO titer was 300. While results were elevated, the patient did no meet clinical criteria for rheumatic fever and diagnosis that was most likely entertained was systemic JIA. Further lab work included an ANA which was negative, rheumatoid factor which was negative, a CRP on admission was 8.6 mg/dL with an ESR about 80. CK and aldolase were within normal limits. Ferritin was elevated at 663. LDH was within normal limits. CBC was reassuring with normal white counts, hemoglobin and platelets; findings nonsuggestive of leukemia. Hepatic panel within normal limits. A chest x-ray was done to rule-out mediastinal mass, and that was negative. From an infectious standpoint, Parvo, CMV, EBV were all negative. Clinically the patient was noted to have a salmon-colored transient rash that would come and go throughout the hospitalization lasting a matter of minutes. No definite arthritis on examination. Oncology was consulted given the history of arthritis and fevers. It was felt in the setting of normal cell lines in evaluating a smear, which revealed no blasts, no indication of hepatomegaly or splenomegaly and uric acid and LDH within normal limits and x-ray that was normal, they felt that further oncologic evaluation was not indicated and a bone marrow was not indicated at that time. Cardiology was also officially consulted because the patient had a 2/6 ejection murmur on the exam. Cardiology felt the murmur was a flow murmur and evaluated the EKG, which they read as within normal limits, and decided an echo was not indicated to rule-out valvular disease in the setting of the rash and arthritis in an attempt to workup acute rheumatic fever. | Internal medicine doc here but in my differential is Adult Onset Stills Disease which can still present in children and Rocky Mountain Spotted Fever. The salmon colored rash lasting a few minutes is textbook for Adult Onset Stills Disease.I'm assuming she had blood cultures done at one or multiple points during her admission. Did she have a procalcitonin tested? Did she receive any antibiotics? Any steroids like solumedrol, prednisone etc? Does she still have joint pain? Does this rash show up only during febrile episodes? Any auto immune conditions in the family like lupus, rheumatoid arthritis, hashimotos? |
[
{
"from": "human",
"value": "NAD. My son has Adult onset stills disease, also considered SJIA when in a child under 16. His symptoms were rash (with fever) that could disappear when the fever went down. Muscle aches, joint pain. Enlarged spleen, liver. Elevated CRP, ESR, ASO, and Ferritin. Liver enzymes elevated from the swelling. He is on high dose prednisone and biologic injections. Hospitalized for 3 weeks.Its rare op, but your sisters case seems so similar. It needs aggressive treatment early on for the best chance of success/possible remission"
},
{
"from": "gpt",
"value": "Yes, the evanescent nature of the rash in this context twigged me to Still's as well. There is a known juvenile onset form that falls under \"SoJIA\" (Systemic-onset Juvenile Idiopathic Arthritis), considered a version of Still's.OP, this sounds exactly like a form of arthritis to a clinician who takes care of children. I agree that what comes to mind for your mother as \"arthritis\" is likely too limited, and that definition might need to be expanded in her mind. Could you look at this, and maybe share it with her? https://www.arthritis.org/diseases/systemic-juvenile-idiopathic-arthritisAbout a third of the way down that page is the SYMPTOMS section, with subsections on Fever, Rash, and Joint Pain. Please read it and see if it rings a bell. Best wishes."
}
] | NAD. My son has Adult onset stills disease, also considered SJIA when in a child under 16. His symptoms were rash (with fever) that could disappear when the fever went down. Muscle aches, joint pain. Enlarged spleen, liver. Elevated CRP, ESR, ASO, and Ferritin. Liver enzymes elevated from the swelling. He is on high dose prednisone and biologic injections. Hospitalized for 3 weeks.Its rare op, but your sisters case seems so similar. It needs aggressive treatment early on for the best chance of success/possible remission | Yes, the evanescent nature of the rash in this context twigged me to Still's as well. There is a known juvenile onset form that falls under "SoJIA" (Systemic-onset Juvenile Idiopathic Arthritis), considered a version of Still's.OP, this sounds exactly like a form of arthritis to a clinician who takes care of children. I agree that what comes to mind for your mother as "arthritis" is likely too limited, and that definition might need to be expanded in her mind. Could you look at this, and maybe share it with her? https://www.arthritis.org/diseases/systemic-juvenile-idiopathic-arthritisAbout a third of the way down that page is the SYMPTOMS section, with subsections on Fever, Rash, and Joint Pain. Please read it and see if it rings a bell. Best wishes. |
[
{
"from": "human",
"value": "27, female, 5ft 8, 190lbs, folic acid & vitamin D supplement medications.I am 16 weeks pregnant and have Wolff Parkinson White syndrome. I was diagnosed in 2012 but have been asymptomatic for around 8 years now. Today I was at maternity and was checked by cardiology where WPW presented itself again on my ECG. I had an 2 ablation attempts in 2012 & 2013 where they werent able to get the extra pathway.How will this affect my pregnancy and delivery options?"
},
{
"from": "gpt",
"value": "It depends on if you have arrhythmias. Have you ever had atrial fibrillation? Did they ever do an exercise stress test?Most of the time it won't effect pregnancy but if you have ever had atrial fibrillation the risk of degrading to a ventricular arrhythmia will be increased in pregnancy.Talk with your cardiologist, it may be beneficial to start a beta blocker depending on your history."
}
] | 27, female, 5ft 8, 190lbs, folic acid & vitamin D supplement medications.I am 16 weeks pregnant and have Wolff Parkinson White syndrome. I was diagnosed in 2012 but have been asymptomatic for around 8 years now. Today I was at maternity and was checked by cardiology where WPW presented itself again on my ECG. I had an 2 ablation attempts in 2012 & 2013 where they werent able to get the extra pathway.How will this affect my pregnancy and delivery options? | It depends on if you have arrhythmias. Have you ever had atrial fibrillation? Did they ever do an exercise stress test?Most of the time it won't effect pregnancy but if you have ever had atrial fibrillation the risk of degrading to a ventricular arrhythmia will be increased in pregnancy.Talk with your cardiologist, it may be beneficial to start a beta blocker depending on your history. |
[
{
"from": "human",
"value": "I'm not sure what details are most important here, so I'll try to sum things up clearly. I need to determine if I should pay for a private autopsy, the problem is money is tight. However, if it's likely someone messed up, I want to take action. This hospital has something of a reputation when it comes to problems with infections, and previously they messed up on a friend of mine, their mistake nearly led to the amputation of her arm. Luckily that time they caught their mistake, and the $250,000 medical bill wasn't placed on my friend.Male665'10\"215 lbhad been on 5mg oxycontin for a bruised rib, took something like 30mg total a dayRough timeline:Day 1 he went to the ER for an infected toe. They referred him to another ER because the infection had spread to the bone and they needed to amputate. His GP said he had no diabetes. He may have had a case of bronchitis.Day 2 he's dealing with bad conditions at the hospital where his surgery will take place due to overcrowding in the non-covid section of the hospital while they give him antibiotics prior to surgery.Day 3 surgery takes place, surgeon reports everything went quickly and smoothly. Dad texts me after, saying everything went well. I talked with him and he sounded tired, but didn't seem out of the ordinary post-op.~14 hours later, a nurse says he was talking with my dad, he was joking with the nurse and the nurse \"got his pain level down\" and continued his rounds. An hour after this, my dad starts to gasp for breath, starts coding and they move him to the cardiology section where he passed.Some possible weirdness:The surgeon led me to believe there would be an autopsy, though he never directly stated there would be one, as he said my dad was relatively young and the surgeon didn't know what could have gone wrong. However, the surgeon had either already signed off on no-autopsy or did shortly thereafter. Going back to our conversation, the surgeon never said \"there will be an autopsy\" he just said \"the coroner will have to tell us what happened\" or something along those lines.I waited for a couple of days to hear back the results, but the hospital then lost my dad and the stuff he had brought in with him, they lost him for something like 4 or 5 days, with us calling every day after the 2nd day after his passing trying to find him and his phone so we could get his contacts and notify people. We still don't have his phone, so we haven't been able to notify all of his friends as the majority of their contact info is in his phone and we don't have it yet."
},
{
"from": "gpt",
"value": "First off, let me say I am very sorry for your loss.All the following assumes you live in the US:I believe the specifics varies by state/county, but any unexpected death (with or without surgery) is by default a coroner's case. This means, someone at the hospital (doctor or nurse) is legally obligated to call the county coroner and report the death. The coroner has the discretion to order an autopsy, i.e. say yes or no they believe one should be done. In this situation, I would think they definitely would, and the body would be transferred to the coroner's office to do it. Even if the coroner says no, they don't require one, the attending doc of the patient can request an autopsy (to be done by the hospital.)I guess in your shoes I would do the following:Contact the surgeon and ask if the case was reported to the coroner. If not, why not. If they did call, what did they say about an autopsy.Then ask how you go about arranging a private autopsy. The surgeon might not know, but should be able to get you in contact with people in the hospital who can help you find out.Any respectable surgeon would want to know what happened just as much as you do. If you find him being evasive on the subject or refusing to return your calls, contact the hospital administration. Admins know medical legal risk and this is absolutely a red flag in that regard."
}
] | I'm not sure what details are most important here, so I'll try to sum things up clearly. I need to determine if I should pay for a private autopsy, the problem is money is tight. However, if it's likely someone messed up, I want to take action. This hospital has something of a reputation when it comes to problems with infections, and previously they messed up on a friend of mine, their mistake nearly led to the amputation of her arm. Luckily that time they caught their mistake, and the $250,000 medical bill wasn't placed on my friend.Male665'10"215 lbhad been on 5mg oxycontin for a bruised rib, took something like 30mg total a dayRough timeline:Day 1 he went to the ER for an infected toe. They referred him to another ER because the infection had spread to the bone and they needed to amputate. His GP said he had no diabetes. He may have had a case of bronchitis.Day 2 he's dealing with bad conditions at the hospital where his surgery will take place due to overcrowding in the non-covid section of the hospital while they give him antibiotics prior to surgery.Day 3 surgery takes place, surgeon reports everything went quickly and smoothly. Dad texts me after, saying everything went well. I talked with him and he sounded tired, but didn't seem out of the ordinary post-op.~14 hours later, a nurse says he was talking with my dad, he was joking with the nurse and the nurse "got his pain level down" and continued his rounds. An hour after this, my dad starts to gasp for breath, starts coding and they move him to the cardiology section where he passed.Some possible weirdness:The surgeon led me to believe there would be an autopsy, though he never directly stated there would be one, as he said my dad was relatively young and the surgeon didn't know what could have gone wrong. However, the surgeon had either already signed off on no-autopsy or did shortly thereafter. Going back to our conversation, the surgeon never said "there will be an autopsy" he just said "the coroner will have to tell us what happened" or something along those lines.I waited for a couple of days to hear back the results, but the hospital then lost my dad and the stuff he had brought in with him, they lost him for something like 4 or 5 days, with us calling every day after the 2nd day after his passing trying to find him and his phone so we could get his contacts and notify people. We still don't have his phone, so we haven't been able to notify all of his friends as the majority of their contact info is in his phone and we don't have it yet. | First off, let me say I am very sorry for your loss.All the following assumes you live in the US:I believe the specifics varies by state/county, but any unexpected death (with or without surgery) is by default a coroner's case. This means, someone at the hospital (doctor or nurse) is legally obligated to call the county coroner and report the death. The coroner has the discretion to order an autopsy, i.e. say yes or no they believe one should be done. In this situation, I would think they definitely would, and the body would be transferred to the coroner's office to do it. Even if the coroner says no, they don't require one, the attending doc of the patient can request an autopsy (to be done by the hospital.)I guess in your shoes I would do the following:Contact the surgeon and ask if the case was reported to the coroner. If not, why not. If they did call, what did they say about an autopsy.Then ask how you go about arranging a private autopsy. The surgeon might not know, but should be able to get you in contact with people in the hospital who can help you find out.Any respectable surgeon would want to know what happened just as much as you do. If you find him being evasive on the subject or refusing to return your calls, contact the hospital administration. Admins know medical legal risk and this is absolutely a red flag in that regard. |
[
{
"from": "human",
"value": "I have had an experience in a hospital like this, as the mom of a patient. The procedure was absolutely botched and we did not find out til later from a nurse who didnt realize they hadnt told us the entire truth. It changed the procedure for pyxis picks in our local hospital, because they picked the wrong medication and it went through two nurses and a pediatrician and was administered to my newborn, premature son.Every business is going to protect its own interests, and I consider doctors a business entity as well as the practices and hospitals. Mistakes are understandable but for a mistake to make it through 3 medical professionals and not be caught til hours after the fact is inexcusable.All this to say, mistakes happen and even on a big scale. I wouldnt think it uncommon for this sort of thing to happen."
},
{
"from": "gpt",
"value": "Interesting assuming your flair is correct and you are not in medicine it seems more likely there was a miscommunication. I've seen bad outcomes but i have never seen or been involved in a \"coverup.\" In PACU Im on the phone with the family/proxy immediately informing them of even relatively mild complications like blood loss requiring transfusion (1-2 units not MTP).At least in general surgery, the patient/their PCP will see what was done on post-op imaging. You can't hide from radiology!"
}
] | I have had an experience in a hospital like this, as the mom of a patient. The procedure was absolutely botched and we did not find out til later from a nurse who didnt realize they hadnt told us the entire truth. It changed the procedure for pyxis picks in our local hospital, because they picked the wrong medication and it went through two nurses and a pediatrician and was administered to my newborn, premature son.Every business is going to protect its own interests, and I consider doctors a business entity as well as the practices and hospitals. Mistakes are understandable but for a mistake to make it through 3 medical professionals and not be caught til hours after the fact is inexcusable.All this to say, mistakes happen and even on a big scale. I wouldnt think it uncommon for this sort of thing to happen. | Interesting assuming your flair is correct and you are not in medicine it seems more likely there was a miscommunication. I've seen bad outcomes but i have never seen or been involved in a "coverup." In PACU Im on the phone with the family/proxy immediately informing them of even relatively mild complications like blood loss requiring transfusion (1-2 units not MTP).At least in general surgery, the patient/their PCP will see what was done on post-op imaging. You can't hide from radiology! |
[
{
"from": "human",
"value": "irst off, I know the pain of losing a parent and Im terribly sorry.Second, NAD, but my field of work happens to be in medical malpractice, specifically investigating licensed medical professionals.Malpractice is generally defined as medical negligence, but this comes in many forms.What I would do is request any and all medical records IF you can legally. Or whoever can, they need to and are allowed under HIPAA. The records we see from doctors are very general, they are required to log and note just about everything and a lot of detailed notes youll never see unless requested.It appears if any negligence happened it was after his passing. The fact that they lost him is NOT ok.Id also be curious to see what medication he received after surgery or in the hours before his passing. Incorrect dosage or medication is a lot more common than people think.Anyway a malpractice attorney may not be the best route yetThey would have a coroner examine the body and can sometimes determine cause of death without an autopsy hasnt a cause of death been given to your family yet?If they cannot determine cause an autopsy would be performed and the family has to consent.The family also has every right to request one, but you may have to pay for it.I would gather that information for sure and any and all medical records"
},
{
"from": "gpt",
"value": "This very sudden event does not sound like a surgical complication. It sounds more like a pulmonary embolus or heart attack, possibly an acute allergic reaction. WITHOUT RECORDS I CANNOT CLAIM THIS AS FACT. Edit: I just noticed you mentioned they moved him to the cardiology floor. A cardiac event seems more likely.You can request a copy of his medical records if you want to know more.Pulmonary embolism was my first thought as well, but of course its my first thought regardless of the situation because, well, gotta CT somethin.Sorry for your loss OP. I hope you are able to find peace within all of this."
}
] | irst off, I know the pain of losing a parent and Im terribly sorry.Second, NAD, but my field of work happens to be in medical malpractice, specifically investigating licensed medical professionals.Malpractice is generally defined as medical negligence, but this comes in many forms.What I would do is request any and all medical records IF you can legally. Or whoever can, they need to and are allowed under HIPAA. The records we see from doctors are very general, they are required to log and note just about everything and a lot of detailed notes youll never see unless requested.It appears if any negligence happened it was after his passing. The fact that they lost him is NOT ok.Id also be curious to see what medication he received after surgery or in the hours before his passing. Incorrect dosage or medication is a lot more common than people think.Anyway a malpractice attorney may not be the best route yetThey would have a coroner examine the body and can sometimes determine cause of death without an autopsy hasnt a cause of death been given to your family yet?If they cannot determine cause an autopsy would be performed and the family has to consent.The family also has every right to request one, but you may have to pay for it.I would gather that information for sure and any and all medical records | This very sudden event does not sound like a surgical complication. It sounds more like a pulmonary embolus or heart attack, possibly an acute allergic reaction. WITHOUT RECORDS I CANNOT CLAIM THIS AS FACT. Edit: I just noticed you mentioned they moved him to the cardiology floor. A cardiac event seems more likely.You can request a copy of his medical records if you want to know more.Pulmonary embolism was my first thought as well, but of course its my first thought regardless of the situation because, well, gotta CT somethin.Sorry for your loss OP. I hope you are able to find peace within all of this. |
[
{
"from": "human",
"value": "In my hospital, the surgeon has no decision making in a coroners case. A mandatory coroners case is if a patient dies within 24 hours of admission. Furthermore, if any patient dies in my hospital, the charge RN or patients RN calls 1) the coroners office. 2) organ donation. 3). The family, and 4) the funeral home or cremation. The surgeon has nothing to do with the decision of a coroners case, the coroner decides. If the coroner decides no autopsy is warranted, the family may have there own independent autopsy completed at their own expense. Your fathers surgeon signed off because your father was no longer his patient. I hope this helps, and I am truly sorry about your father."
},
{
"from": "gpt",
"value": "Saying that hospital staff killed your dad is a bit of a stretch, but you do deserve an autopsy like you asked for.Reaching out to get records from the hospital and getting a lawyer could help. You could also reach out to the medical examiners office and see if theyre even aware of this case, if they havent heard of it, or if they rejected it."
}
] | In my hospital, the surgeon has no decision making in a coroners case. A mandatory coroners case is if a patient dies within 24 hours of admission. Furthermore, if any patient dies in my hospital, the charge RN or patients RN calls 1) the coroners office. 2) organ donation. 3). The family, and 4) the funeral home or cremation. The surgeon has nothing to do with the decision of a coroners case, the coroner decides. If the coroner decides no autopsy is warranted, the family may have there own independent autopsy completed at their own expense. Your fathers surgeon signed off because your father was no longer his patient. I hope this helps, and I am truly sorry about your father. | Saying that hospital staff killed your dad is a bit of a stretch, but you do deserve an autopsy like you asked for.Reaching out to get records from the hospital and getting a lawyer could help. You could also reach out to the medical examiners office and see if theyre even aware of this case, if they havent heard of it, or if they rejected it. |
[
{
"from": "human",
"value": "Is there a way to get a coroner to do it? The county coroner said they won't since the surgeon signed off on it, so as far as I'm aware I need to get a private autopsy done, which is a pretty large financial burden at around $7,000. I'll absolutely pay for it if it's at all likely that they messed up. I can't stand the thought that they could face no repercussions for any mistakes they made."
},
{
"from": "gpt",
"value": "Its really hard to connect a sudden event like this to a relatively benign surgery i.e. toe amputation. I cant envision a scenario where the surgery was a direct cause of his death. If it was a PE and he wasnt getting SQ heparin in the hospital, maybe you have a case, but even that might be a stretch. The vast majority of deaths in the hospital were beyond anyones control, but of course there are exceptions. Despite popular belief, its hard to kill people.I think it's most likely that they didn't make any mistake that caused this death, especially with just an amp of a digit, but I would think this definitely would deserve an autopsy. He probably had a PE, STEMI, something catastrophic either unrelated to the surgery or a very unfortunate complication of the surgery, and was in a part of the hospital for very non-acute patients that don't really need much monitoring when it happened."
}
] | Is there a way to get a coroner to do it? The county coroner said they won't since the surgeon signed off on it, so as far as I'm aware I need to get a private autopsy done, which is a pretty large financial burden at around $7,000. I'll absolutely pay for it if it's at all likely that they messed up. I can't stand the thought that they could face no repercussions for any mistakes they made. | Its really hard to connect a sudden event like this to a relatively benign surgery i.e. toe amputation. I cant envision a scenario where the surgery was a direct cause of his death. If it was a PE and he wasnt getting SQ heparin in the hospital, maybe you have a case, but even that might be a stretch. The vast majority of deaths in the hospital were beyond anyones control, but of course there are exceptions. Despite popular belief, its hard to kill people.I think it's most likely that they didn't make any mistake that caused this death, especially with just an amp of a digit, but I would think this definitely would deserve an autopsy. He probably had a PE, STEMI, something catastrophic either unrelated to the surgery or a very unfortunate complication of the surgery, and was in a part of the hospital for very non-acute patients that don't really need much monitoring when it happened. |
[
{
"from": "human",
"value": "Im a 32 year old male, smoked tobacco from 18-22 and switched to vaping, regular use of marijuana and no other drug use since age 22, I used to abuse cocaine. Went to the ER twice, once for a short lived but stabbing center chest pain, other visit I was sitting watching videos and my heart started pounding out of my chest and reach 150-160bpm, but absent of pain, both times EKG and X-ray were explained as unremarkable and was given an ER diagnosis of palpitations/anxiety. I went to my PCP yesterday and he asked if any of the ER staff mentioned a incomplete RBBB. I told him they did not, I reached out to ER doctor and he said the computer read out printed an incomplete RBBB on the paper but upon human examination it wasnt the case and was likely caused by me being underweight. My PCP said this is highly unlikely and ordered a chemical stress test and a cardiology appointment for May 5th, I trust my PCP but hes new to me so I dont know him very well. Can an EKG false read a RBBB or is my PCP correct to be suspicious? If I do have an Incomplete RBBB what does that mean for someone my age? Waiting on the next appointment is giving me anxiety and just want to understand more about whats happening. Thank you in advance for your help! I have a family history of stroke but not cardiac failure."
},
{
"from": "gpt",
"value": "An incomplete RBBB is generally a benign and incidental finding. I would not worry about it at all. I often dont mention it to patients if I see it on their EKG because it doesnt really meaningfully increase risk of anything nor does it typically indicate underlying cardiac disease. Think if it as simply just being the way your heart is wired."
}
] | Im a 32 year old male, smoked tobacco from 18-22 and switched to vaping, regular use of marijuana and no other drug use since age 22, I used to abuse cocaine. Went to the ER twice, once for a short lived but stabbing center chest pain, other visit I was sitting watching videos and my heart started pounding out of my chest and reach 150-160bpm, but absent of pain, both times EKG and X-ray were explained as unremarkable and was given an ER diagnosis of palpitations/anxiety. I went to my PCP yesterday and he asked if any of the ER staff mentioned a incomplete RBBB. I told him they did not, I reached out to ER doctor and he said the computer read out printed an incomplete RBBB on the paper but upon human examination it wasnt the case and was likely caused by me being underweight. My PCP said this is highly unlikely and ordered a chemical stress test and a cardiology appointment for May 5th, I trust my PCP but hes new to me so I dont know him very well. Can an EKG false read a RBBB or is my PCP correct to be suspicious? If I do have an Incomplete RBBB what does that mean for someone my age? Waiting on the next appointment is giving me anxiety and just want to understand more about whats happening. Thank you in advance for your help! I have a family history of stroke but not cardiac failure. | An incomplete RBBB is generally a benign and incidental finding. I would not worry about it at all. I often dont mention it to patients if I see it on their EKG because it doesnt really meaningfully increase risk of anything nor does it typically indicate underlying cardiac disease. Think if it as simply just being the way your heart is wired. |
[
{
"from": "human",
"value": "34F, Canada, Cushings Disease with associated type 2 diabetes, hypertension, etc.One week ago I underwent a transsphenoidal pituitary adenoma resection. Midway through the surgery my heart stopped and they had to give me CPR. Not sure how long I was out for (the doctor said I was back before he had time to get the life-saving medications). My heart stopped again right at the end of the surgery. I woke up from anesthesia having my chest x-rayed and being asked a bunch of questions to see if I had any neurological damage.X-ray showed no fractures and ECGs were normal. The cardiology team didnt really know what happened and just said something about a vasovagal response with asystole. They discharged me from their care. I ended up developing diabetes insipidus so I spent 5 days in hospital.My chest still hurts something fierce. The headaches, fatigue and the hormonal rollercoaster from the tumour being removed is a walk in the park in comparison.Is the pain just muscular if the X-rays were clear? How long can I expect this to last? I feel like I cant take deep breaths or move my arms without pain. I complain but Im very grateful to the doctors who saved me!Should I be cautious going under general anesthesia in the future or was this just a freak thing?Thank you!"
},
{
"from": "gpt",
"value": "That certainly sounds like a challenging case.You should review what happened with the anesthesiologist as they can provide the necessary context and course of events to what happened. Having the anesthetic record available will also be invaluable.Also, brain surgery carries additional risks, with significant pauses in heart rate being due to several different mechanisms. Most likely, this will not be an issue in other surgeries. However, it is impossible to know without more information.As for your chest pain, while broken ribs can happen, there can also be pain in the joints as well as muscles and other tissues. The soreness should eventually get better in the next week or so."
}
] | 34F, Canada, Cushings Disease with associated type 2 diabetes, hypertension, etc.One week ago I underwent a transsphenoidal pituitary adenoma resection. Midway through the surgery my heart stopped and they had to give me CPR. Not sure how long I was out for (the doctor said I was back before he had time to get the life-saving medications). My heart stopped again right at the end of the surgery. I woke up from anesthesia having my chest x-rayed and being asked a bunch of questions to see if I had any neurological damage.X-ray showed no fractures and ECGs were normal. The cardiology team didnt really know what happened and just said something about a vasovagal response with asystole. They discharged me from their care. I ended up developing diabetes insipidus so I spent 5 days in hospital.My chest still hurts something fierce. The headaches, fatigue and the hormonal rollercoaster from the tumour being removed is a walk in the park in comparison.Is the pain just muscular if the X-rays were clear? How long can I expect this to last? I feel like I cant take deep breaths or move my arms without pain. I complain but Im very grateful to the doctors who saved me!Should I be cautious going under general anesthesia in the future or was this just a freak thing?Thank you! | That certainly sounds like a challenging case.You should review what happened with the anesthesiologist as they can provide the necessary context and course of events to what happened. Having the anesthetic record available will also be invaluable.Also, brain surgery carries additional risks, with significant pauses in heart rate being due to several different mechanisms. Most likely, this will not be an issue in other surgeries. However, it is impossible to know without more information.As for your chest pain, while broken ribs can happen, there can also be pain in the joints as well as muscles and other tissues. The soreness should eventually get better in the next week or so. |
[
{
"from": "human",
"value": "Thank you! Yes all the doctors seem a bit mystified by it. I have follow-ups with the surgeons in a couple weeks so I will get more details. I admit to feeling a bit freaked out by the experience. And the chest pain has been killer."
},
{
"from": "gpt",
"value": "Broken ribs are notoriously hard to see on X-rays were looking more for breaks that are also very out of place, or a collapsed lung from the fracture. So you could very well have a broken rib that wasnt seen."
}
] | Thank you! Yes all the doctors seem a bit mystified by it. I have follow-ups with the surgeons in a couple weeks so I will get more details. I admit to feeling a bit freaked out by the experience. And the chest pain has been killer. | Broken ribs are notoriously hard to see on X-rays were looking more for breaks that are also very out of place, or a collapsed lung from the fracture. So you could very well have a broken rib that wasnt seen. |
[
{
"from": "human",
"value": "26F. 510, 150lbs. Non smoker, exercise 2x per week.I had an episode a few weeks ago where I felt lightheaded for about 15 minutes. I also had heart palpitations and feel very anxious (heart palpitations started after light headedness). This improved with deep breaths. I havent had an episode like this previously but have in the past felt heart palpitations when stressed.I spoke to a doctor at the time who sent me to the ER. I had blood tests, 2 ECGs, blood pressure tests and an X-ray which were all normal, but was sent to cardiology as a follow up.I have also since spoke with a GP who said they likely think my symptoms were a panic attack as I do suffer from anxiety and health anxiety. That said, I still have to see a cardiologist to confirm.I have my appointment tomorrow and Im very anxious about it. What will happen? Whats the likeliness of needing further tests and what would they be? Im worried about having to do a lot of follow up tests as Im travelling soon and need to be fit to travel"
},
{
"from": "gpt",
"value": "They might just talk to you about your symptoms and what happened. Family heart disease history. Might have you wear a heart monitor to catch any arrhythmias that might happen if/when you feel lightheaded etc. or do an echocardiogram but I say might given that you only had one episode and all blood work / ekg are normal."
}
] | 26F. 510, 150lbs. Non smoker, exercise 2x per week.I had an episode a few weeks ago where I felt lightheaded for about 15 minutes. I also had heart palpitations and feel very anxious (heart palpitations started after light headedness). This improved with deep breaths. I havent had an episode like this previously but have in the past felt heart palpitations when stressed.I spoke to a doctor at the time who sent me to the ER. I had blood tests, 2 ECGs, blood pressure tests and an X-ray which were all normal, but was sent to cardiology as a follow up.I have also since spoke with a GP who said they likely think my symptoms were a panic attack as I do suffer from anxiety and health anxiety. That said, I still have to see a cardiologist to confirm.I have my appointment tomorrow and Im very anxious about it. What will happen? Whats the likeliness of needing further tests and what would they be? Im worried about having to do a lot of follow up tests as Im travelling soon and need to be fit to travel | They might just talk to you about your symptoms and what happened. Family heart disease history. Might have you wear a heart monitor to catch any arrhythmias that might happen if/when you feel lightheaded etc. or do an echocardiogram but I say might given that you only had one episode and all blood work / ekg are normal. |
[
{
"from": "human",
"value": "Gender: Male. Age: 21. Weight: 160. Diagnosed with asthma.Some months ago, I went into the emergency room for heart palpitations. I am prone to heart palpitations during anxiety, but those are caused by tachycardia. They feel like a fluttering in my chest. These heart palpitations feel like my heart stops and then THUDS into my chest. When I went into the emergency room, they were relatively infrequent. I was referred to a cardiologist.During my cardiology appointment, the doctor told me that I had a heart murmur. He ordered an echocardiogram, an MCOT monitor and a stress test. The echocardiogram came back negative for any abnormalities and I have four days left on my MCOT monitor (which is like a monitor that sits on a patch above my heart and monitors my heart rhythm 24/7). I never had the stress test done.Since that appointment, I've had these beats relatively infrequently. Maybe four times a night tops.Starting last night, I began to have them much more frequently. Much more frequently. And it is only one PM and it's happening maybe two or three times already. My question iswhen are these skipped beats concerning? When should I be worried about dying? Should I go to an emergency room?"
},
{
"from": "gpt",
"value": "There honestly isn't any indication to go into the ER if you're wearing the MCOT monitor. While you have it on, detection of an arrhythmia is automatically transmitted to a central surveillance station for further analysis and possible intervention. If something concerning or life threatening was going on, someone would call you about it immediately."
}
] | Gender: Male. Age: 21. Weight: 160. Diagnosed with asthma.Some months ago, I went into the emergency room for heart palpitations. I am prone to heart palpitations during anxiety, but those are caused by tachycardia. They feel like a fluttering in my chest. These heart palpitations feel like my heart stops and then THUDS into my chest. When I went into the emergency room, they were relatively infrequent. I was referred to a cardiologist.During my cardiology appointment, the doctor told me that I had a heart murmur. He ordered an echocardiogram, an MCOT monitor and a stress test. The echocardiogram came back negative for any abnormalities and I have four days left on my MCOT monitor (which is like a monitor that sits on a patch above my heart and monitors my heart rhythm 24/7). I never had the stress test done.Since that appointment, I've had these beats relatively infrequently. Maybe four times a night tops.Starting last night, I began to have them much more frequently. Much more frequently. And it is only one PM and it's happening maybe two or three times already. My question iswhen are these skipped beats concerning? When should I be worried about dying? Should I go to an emergency room? | There honestly isn't any indication to go into the ER if you're wearing the MCOT monitor. While you have it on, detection of an arrhythmia is automatically transmitted to a central surveillance station for further analysis and possible intervention. If something concerning or life threatening was going on, someone would call you about it immediately. |
[
{
"from": "human",
"value": "Wellthe people monitoring the data have made it clear that MCOT isn't an emergency service and that all of the information from the monitor is being sent to my cardiologistwho isn't at work until tomorrow. So my thoughts are that he hasn't even seen any of my data since this has started. I just had another skipped beat. They're happening very frequently.The site says that they will only contact me if specifically requested by my physician, who isn't working weekends. I'm quite scared because these beats are happening much more frequently than normal."
},
{
"from": "gpt",
"value": "Are you having any other symptoms with the skipped beats? Like chest pain, shortness of breath, lightheadedness/dizziness, vision changes, or numbness/weakness/tingling anywhere, that's any different from your baseline? If so, then those would be indications to present to an ER."
}
] | Wellthe people monitoring the data have made it clear that MCOT isn't an emergency service and that all of the information from the monitor is being sent to my cardiologistwho isn't at work until tomorrow. So my thoughts are that he hasn't even seen any of my data since this has started. I just had another skipped beat. They're happening very frequently.The site says that they will only contact me if specifically requested by my physician, who isn't working weekends. I'm quite scared because these beats are happening much more frequently than normal. | Are you having any other symptoms with the skipped beats? Like chest pain, shortness of breath, lightheadedness/dizziness, vision changes, or numbness/weakness/tingling anywhere, that's any different from your baseline? If so, then those would be indications to present to an ER. |
[
{
"from": "human",
"value": "Whenever I have the skipped beat sensations, there's like an anxious feeling in my chest and sort of a feeling like my body is heavy. It is the same sensation that I get during panic attacks but much less severe. The sensation never lasts. It goes away immediately after the beat. I'm terrified these fuckers are going to kill me. I have no idea why all of a sudden these are happening so frequently."
},
{
"from": "gpt",
"value": "It sounds like PVCs (premature ventricular contractions) which feel weird but arent life threatening."
}
] | Whenever I have the skipped beat sensations, there's like an anxious feeling in my chest and sort of a feeling like my body is heavy. It is the same sensation that I get during panic attacks but much less severe. The sensation never lasts. It goes away immediately after the beat. I'm terrified these fuckers are going to kill me. I have no idea why all of a sudden these are happening so frequently. | It sounds like PVCs (premature ventricular contractions) which feel weird but arent life threatening. |
[
{
"from": "human",
"value": "Thank you so much! I was told I had a blockage of some kind? I cant remember exactly what its called now. Essentially the 2 parts of my heart arent in sync with each other. Thats why I got the heart monitor. Is that something to worry about?"
},
{
"from": "gpt",
"value": "CMS/HCC is just a designation for billing stuff (CMS = Center for Medicare/Medicaid Services).\"Ambulatory referral\" - referral to an outpatient cardiologist (not being sent to see them urgently in the hospital)Syncope is the medical term for fainting, or becoming unconscious.The optic disc is a spot in the back of your eye where we can see the nerve that gets information from your eye and brings it to the brain. \"Anomaly\" just means that something looks funny (since they don't say anything else here, I can't say how it looks funny).In short, for your passing out or possible seizures, they're sending you to see a cardiologist to make sure it isn't your heart. For the funny thing they saw in the back of your eye, they're having you see an ophthalmologist. Sounds like all of this is a very reasonable workup for your issues.Hard to say with that general explanation - it'd be more helpful if you have the medical name of the condition."
}
] | Thank you so much! I was told I had a blockage of some kind? I cant remember exactly what its called now. Essentially the 2 parts of my heart arent in sync with each other. Thats why I got the heart monitor. Is that something to worry about? | CMS/HCC is just a designation for billing stuff (CMS = Center for Medicare/Medicaid Services)."Ambulatory referral" - referral to an outpatient cardiologist (not being sent to see them urgently in the hospital)Syncope is the medical term for fainting, or becoming unconscious.The optic disc is a spot in the back of your eye where we can see the nerve that gets information from your eye and brings it to the brain. "Anomaly" just means that something looks funny (since they don't say anything else here, I can't say how it looks funny).In short, for your passing out or possible seizures, they're sending you to see a cardiologist to make sure it isn't your heart. For the funny thing they saw in the back of your eye, they're having you see an ophthalmologist. Sounds like all of this is a very reasonable workup for your issues.Hard to say with that general explanation - it'd be more helpful if you have the medical name of the condition. |
[
{
"from": "human",
"value": "I believe its a first degree atrioventricular block."
},
{
"from": "gpt",
"value": "Based on his username the original respondent is the best to answer this question though."
}
] | I believe its a first degree atrioventricular block. | Based on his username the original respondent is the best to answer this question though. |
[
{
"from": "human",
"value": "27F. 213 pounds.Preexisting conditions: pcos, endometriosis, factor V, anxiety, depression, and under active thyroid Medications: propanol 40mg, levothyroxineLast year I started having random heart palpitations. I went to the ER. I had an ekg. In the ER they determined I was normal so they gave me a referral to cardiology. Since then Ive had a 30 day heart monitor, echo, and a stress test. Im told that all the results read normal and Its probably anxiety playing a part.On Friday I had a weird sensation happen. Its happened a handful of times and I mainly feel it at nighttime while laying down. It is in the middle of my chest and its a cross between a flutter and a spasm. Like it gets tight for a second. It makes me cough and I breathe in to get it to stop. I can also slightly feel them in my lower neck beating. I also woke up this morning a little weak in that area. It freaks me out.I have some slight occasional pinching just like I do with the other palpitations (Im told that can be normal ) but Im not in pain. I dont have a headache. My blood sugar is normal. My bpm is normal. My blood pressure is a little lower than where it usually sits but its still in the range.Im seeing a NP on Monday but I wanted to ask if anyone has experienced this or knows what it might be before I get told its just anxiety again.Disclaimer: Im not saying it cant be anxiety but every time I go to the doctor EVERYTHING under the sun is anxiety and its hard to get past that diagnoses when you feel like something is off"
},
{
"from": "gpt",
"value": "The workup youve had is incredibly thorough and it couldnt find anything pathological. Short of a heart attack (which is almost impossible at your age) there wouldnt be any significant changes to your cardiac physiology since that battery of tests was done.Anxiety is by far the most likely cause.From the sounds of it, it is probably anxiety."
}
] | 27F. 213 pounds.Preexisting conditions: pcos, endometriosis, factor V, anxiety, depression, and under active thyroid Medications: propanol 40mg, levothyroxineLast year I started having random heart palpitations. I went to the ER. I had an ekg. In the ER they determined I was normal so they gave me a referral to cardiology. Since then Ive had a 30 day heart monitor, echo, and a stress test. Im told that all the results read normal and Its probably anxiety playing a part.On Friday I had a weird sensation happen. Its happened a handful of times and I mainly feel it at nighttime while laying down. It is in the middle of my chest and its a cross between a flutter and a spasm. Like it gets tight for a second. It makes me cough and I breathe in to get it to stop. I can also slightly feel them in my lower neck beating. I also woke up this morning a little weak in that area. It freaks me out.I have some slight occasional pinching just like I do with the other palpitations (Im told that can be normal ) but Im not in pain. I dont have a headache. My blood sugar is normal. My bpm is normal. My blood pressure is a little lower than where it usually sits but its still in the range.Im seeing a NP on Monday but I wanted to ask if anyone has experienced this or knows what it might be before I get told its just anxiety again.Disclaimer: Im not saying it cant be anxiety but every time I go to the doctor EVERYTHING under the sun is anxiety and its hard to get past that diagnoses when you feel like something is off | The workup youve had is incredibly thorough and it couldnt find anything pathological. Short of a heart attack (which is almost impossible at your age) there wouldnt be any significant changes to your cardiac physiology since that battery of tests was done.Anxiety is by far the most likely cause.From the sounds of it, it is probably anxiety. |
[
{
"from": "human",
"value": "I (24F) had an ekg done yesterday to investigate consistently high blood pressure (around 140/85 or higher) and both high (122bpm) and low (53bpm) heart rates. The ekg showed that I have a heart block and they explained that my heart is skipping beats and part of it is beating slower? They seemed pretty concerned and asked if I had any chest pain or dizziness, which I said no - but that I am almost constantly nauseated and tired.I have a lifelong history with nausea and fainting that Ive learned to control by avoiding triggers like heat, cardio, or becoming overwhelmed emotionally. They said since Ive been experiencing symptoms for so long, its probably not immediately life threatening and sent me home. But they insisted that I go to the ER if I feel like Im going to faint at any point and I was given an urgent referral to cardiology. How concerned should I be?Stats: 24F; very rarely drink, no cigarettes, no vaping, daily weed; Diagnosed with bipolar, adhd, and anxiety; Currently taking Trileptal 675mg and lexapro 10mg"
},
{
"from": "gpt",
"value": "There are many types of heart block of various degrees of seriousness. It's not possible to say from this info what you have"
}
] | I (24F) had an ekg done yesterday to investigate consistently high blood pressure (around 140/85 or higher) and both high (122bpm) and low (53bpm) heart rates. The ekg showed that I have a heart block and they explained that my heart is skipping beats and part of it is beating slower? They seemed pretty concerned and asked if I had any chest pain or dizziness, which I said no - but that I am almost constantly nauseated and tired.I have a lifelong history with nausea and fainting that Ive learned to control by avoiding triggers like heat, cardio, or becoming overwhelmed emotionally. They said since Ive been experiencing symptoms for so long, its probably not immediately life threatening and sent me home. But they insisted that I go to the ER if I feel like Im going to faint at any point and I was given an urgent referral to cardiology. How concerned should I be?Stats: 24F; very rarely drink, no cigarettes, no vaping, daily weed; Diagnosed with bipolar, adhd, and anxiety; Currently taking Trileptal 675mg and lexapro 10mg | There are many types of heart block of various degrees of seriousness. It's not possible to say from this info what you have |
[
{
"from": "human",
"value": "Depends on the type of block you have. Is it a first or second degree, Mobitz or Wenkebach?For a third degree, you'd've had to stay in the hospital, I guess."
},
{
"from": "gpt",
"value": "Or bundle branch or fascicular."
}
] | Depends on the type of block you have. Is it a first or second degree, Mobitz or Wenkebach?For a third degree, you'd've had to stay in the hospital, I guess. | Or bundle branch or fascicular. |
[
{
"from": "human",
"value": "I'm a 19 female, no drinks no drugs no smoke, \"loose ligament syndrome\"(modern day gHSD and hEDS, basically hypermobility spectrum disorders) runs down the matrilineal line. I couldn't inherit the diagnosis because diagnostic process changed, but same symptoms. Because of that, I'm very sedentary- chronic pain and bad joints makes even walking difficult to do for any extended period of time.Because of the loose ligament syndrome thing, I was supposed to have seen a cardiologist a while ago(if it's hEDS, increased risk of aortal dilation). On top of that, just learned maternal grandmother is also medicated for high cholesterol and bp, and had a heart murmur.I just scheduled a doctor's appointment for the 18th of February- just with my gp for a physical, and I'll go from there. Scheduled it after I went to an urgent care for something unrelated and they took my bpm three times(137, then 111 laying down, then 102 as they had me meditate for a minute). I have tons of symptoms that I just attributed to an autonomic condition like pots or something, and didn't bother treating because \"it's not fatal\"- common mentality in my family. However, these symptoms all also apply to cardiac issues. Things like chest pain spreading to shoulder blades + neck, feeling like a lump in my neck during hot shower + palpitations, blood pooling in my feet, breathlessness, dizziness, cold hands and feet, etc etc. I'm also wearing a Fitbit to help give general metrics(I know Fitbits aren't concise) to the gp.Anyways, because of these symptoms, I'm concerned that my gp will hear this and send me to the er (the gp office is connected to a hospital), rather than referring me to cardiology. These are all symptoms I've dealt with for months if not years. Not entirely afraid of that, I just like knowing what to expect and am trying to mentally map out possibilities.I'm curious to know at what point a doctor decides to refer a patient vs send them to the er? Especially if it's something the patient has been dealing with for a while(like in my case), vs something brand new?Update: nevermind had a heart event and I'm at the er now. So, fun reminder to go to the er when the internet tells you to, rather than waiting it out."
},
{
"from": "gpt",
"value": "As an ER doc, I can hopefully help map out the in's and out's of what \"should\" dictate a referral to a specialist vs. what constitutes the need for a recommendation to go to the ER.The answer is...you ready for this?...If the presentation is...an emergency. Poof. Mind blown...\"You condescending asshole!\" I hear you saying to yourself. But, no, seriously, this is power to you. IF your PCP, for some odd and unnecessary reason, says, \"Based on your symptoms, you need to go to the ER. NOW!\" Calmly tell him, or her, \"But, I thought that dark and scary soul-sucking hell-hole was only for emergencies. Yet, I've had these symptoms for months. Why is this suddenly so emergent? Please just refer me to a cardiologist who can help me with my chronic cardiac issues.\" Then, feel free to bat your eyelashes, if you so choose, as they sit in the cesspool of being completely and totally wrecked by reason."
}
] | I'm a 19 female, no drinks no drugs no smoke, "loose ligament syndrome"(modern day gHSD and hEDS, basically hypermobility spectrum disorders) runs down the matrilineal line. I couldn't inherit the diagnosis because diagnostic process changed, but same symptoms. Because of that, I'm very sedentary- chronic pain and bad joints makes even walking difficult to do for any extended period of time.Because of the loose ligament syndrome thing, I was supposed to have seen a cardiologist a while ago(if it's hEDS, increased risk of aortal dilation). On top of that, just learned maternal grandmother is also medicated for high cholesterol and bp, and had a heart murmur.I just scheduled a doctor's appointment for the 18th of February- just with my gp for a physical, and I'll go from there. Scheduled it after I went to an urgent care for something unrelated and they took my bpm three times(137, then 111 laying down, then 102 as they had me meditate for a minute). I have tons of symptoms that I just attributed to an autonomic condition like pots or something, and didn't bother treating because "it's not fatal"- common mentality in my family. However, these symptoms all also apply to cardiac issues. Things like chest pain spreading to shoulder blades + neck, feeling like a lump in my neck during hot shower + palpitations, blood pooling in my feet, breathlessness, dizziness, cold hands and feet, etc etc. I'm also wearing a Fitbit to help give general metrics(I know Fitbits aren't concise) to the gp.Anyways, because of these symptoms, I'm concerned that my gp will hear this and send me to the er (the gp office is connected to a hospital), rather than referring me to cardiology. These are all symptoms I've dealt with for months if not years. Not entirely afraid of that, I just like knowing what to expect and am trying to mentally map out possibilities.I'm curious to know at what point a doctor decides to refer a patient vs send them to the er? Especially if it's something the patient has been dealing with for a while(like in my case), vs something brand new?Update: nevermind had a heart event and I'm at the er now. So, fun reminder to go to the er when the internet tells you to, rather than waiting it out. | As an ER doc, I can hopefully help map out the in's and out's of what "should" dictate a referral to a specialist vs. what constitutes the need for a recommendation to go to the ER.The answer is...you ready for this?...If the presentation is...an emergency. Poof. Mind blown..."You condescending asshole!" I hear you saying to yourself. But, no, seriously, this is power to you. IF your PCP, for some odd and unnecessary reason, says, "Based on your symptoms, you need to go to the ER. NOW!" Calmly tell him, or her, "But, I thought that dark and scary soul-sucking hell-hole was only for emergencies. Yet, I've had these symptoms for months. Why is this suddenly so emergent? Please just refer me to a cardiologist who can help me with my chronic cardiac issues." Then, feel free to bat your eyelashes, if you so choose, as they sit in the cesspool of being completely and totally wrecked by reason. |
[
{
"from": "human",
"value": "Yeah I put an update at the bottom, I'm at the ER after a cardiac event"
},
{
"from": "gpt",
"value": "Ahhh dang. At the very least, I hope you get feeling better soon!"
}
] | Yeah I put an update at the bottom, I'm at the ER after a cardiac event | Ahhh dang. At the very least, I hope you get feeling better soon! |
[
{
"from": "human",
"value": "My mother has undergone an MRI brain without contract as she was suffering from double vision, major headaches, fatigue, imbalance, and frequent of coordination. The MRI scan consequently showed a small 7x4 mm nonspecific focal area of white matter high signal change seen on T2 and FLAIR sequences in the left centrum semiovale. The neurologist then advised to undergo a CT contrast scan alongside a lipid panel test to infer on the MRI findings.As per the CT scan, below were the findings:Atherosclerotic changesOcclusion of the right vertebral artery at the origin, partial visualization of the cervical segment, retrograde filling of the distal V4 segment and PICASignificant narrowing of the left PCA distal P2 and P3 segmentMild narrowing of the proximal right ICA about 40%.Right A1 segment is congenitally absent, the rest of the right ACA is hypoplasticThe lipid panel test showed the following:Lipid panel-LDL 3.34, total cholesterol 5.61Momentarily, the neurologist has requested a HBA1C and liver function exam, in addition to the echocardiogram and a 24-hour blood pressure monitoring from cardiology standpoint. He has concluded that the previous MRI reported a lesion suggestive of old ischemic infarct.I am looking for advice regarding the next viable steps as the healthcare from the country I am currently in is not up to par/adequate. I am extremely distressed and worried about this case as my father has suffered from a hemorrhagic brain stroke 12 years ago and cannot lose another parent as a result of a medical condition. I am the sole carer of both my parents who works 10 hours a day. Please advise me."
},
{
"from": "gpt",
"value": "It is not uncommon to have small, old infarcts as people get older.The important thing to do if these are seen is secondary prevention, meaning modifying risk factors to prevent future infarcts. This sounds like it is already taking place through the measurement of her HbA1c and lipid profile.As to whether anything is done about the existing vessel narrowing will depend on her particular case and where in the world you are and should be discussed with her team."
}
] | My mother has undergone an MRI brain without contract as she was suffering from double vision, major headaches, fatigue, imbalance, and frequent of coordination. The MRI scan consequently showed a small 7x4 mm nonspecific focal area of white matter high signal change seen on T2 and FLAIR sequences in the left centrum semiovale. The neurologist then advised to undergo a CT contrast scan alongside a lipid panel test to infer on the MRI findings.As per the CT scan, below were the findings:Atherosclerotic changesOcclusion of the right vertebral artery at the origin, partial visualization of the cervical segment, retrograde filling of the distal V4 segment and PICASignificant narrowing of the left PCA distal P2 and P3 segmentMild narrowing of the proximal right ICA about 40%.Right A1 segment is congenitally absent, the rest of the right ACA is hypoplasticThe lipid panel test showed the following:Lipid panel-LDL 3.34, total cholesterol 5.61Momentarily, the neurologist has requested a HBA1C and liver function exam, in addition to the echocardiogram and a 24-hour blood pressure monitoring from cardiology standpoint. He has concluded that the previous MRI reported a lesion suggestive of old ischemic infarct.I am looking for advice regarding the next viable steps as the healthcare from the country I am currently in is not up to par/adequate. I am extremely distressed and worried about this case as my father has suffered from a hemorrhagic brain stroke 12 years ago and cannot lose another parent as a result of a medical condition. I am the sole carer of both my parents who works 10 hours a day. Please advise me. | It is not uncommon to have small, old infarcts as people get older.The important thing to do if these are seen is secondary prevention, meaning modifying risk factors to prevent future infarcts. This sounds like it is already taking place through the measurement of her HbA1c and lipid profile.As to whether anything is done about the existing vessel narrowing will depend on her particular case and where in the world you are and should be discussed with her team. |
[
{
"from": "human",
"value": "Thank you for your reply. Greatly appreciated. Could I just ask in regards to the occlusion of the right vertebral artery and the 40% narrowing of the ICA - how dangerous/worrisome are those findings and should we opt for any surgical intervention?The neurologist has suggested to get her on Lipitor 20mg daily for 3 months and an anti platelet treatment (although she took aspirin before and had a huge drop in ferritin levels equating to 2.7 and edema, which led to her having to get iron infusions). The neurologist hence recommended plavix as an alternative."
},
{
"from": "gpt",
"value": "This will again depend on local practice and your mothers wider medical history and functional status.As an example, in my region we wouldnt consider it unless stenosis was greater than 50% and even then, the vertebral arteries are very difficult to access safely and generally only consider thrombectomy of small vessels in the acute phase."
}
] | Thank you for your reply. Greatly appreciated. Could I just ask in regards to the occlusion of the right vertebral artery and the 40% narrowing of the ICA - how dangerous/worrisome are those findings and should we opt for any surgical intervention?The neurologist has suggested to get her on Lipitor 20mg daily for 3 months and an anti platelet treatment (although she took aspirin before and had a huge drop in ferritin levels equating to 2.7 and edema, which led to her having to get iron infusions). The neurologist hence recommended plavix as an alternative. | This will again depend on local practice and your mothers wider medical history and functional status.As an example, in my region we wouldnt consider it unless stenosis was greater than 50% and even then, the vertebral arteries are very difficult to access safely and generally only consider thrombectomy of small vessels in the acute phase. |
[
{
"from": "human",
"value": "In regards to medical history, my mother has been extremely healthy, no smoking or drinking, and no other medical issues. However, it is essential to note that her father and sibling have passed away from a heart attack, and two others have undergone open heart surgery.So, from my understanding, operating on the vertebral artery is extremely dangerous, and for any other stent operations regarding intracranial and extra cranial arteries, the stenosis should be larger than 50%? But what is the likelihood of her ICA percentage growing to 50% and in how long? Considering she suffered from an transient ischemic attack recently reflecting in the MRI, how would you assess this case?"
},
{
"from": "gpt",
"value": "The number of 50% is an example of what we would use in my local practice - it does not necessarily represent the targets in your area/situation. That is a much more nuanced question that can only be answered by your team."
}
] | In regards to medical history, my mother has been extremely healthy, no smoking or drinking, and no other medical issues. However, it is essential to note that her father and sibling have passed away from a heart attack, and two others have undergone open heart surgery.So, from my understanding, operating on the vertebral artery is extremely dangerous, and for any other stent operations regarding intracranial and extra cranial arteries, the stenosis should be larger than 50%? But what is the likelihood of her ICA percentage growing to 50% and in how long? Considering she suffered from an transient ischemic attack recently reflecting in the MRI, how would you assess this case? | The number of 50% is an example of what we would use in my local practice - it does not necessarily represent the targets in your area/situation. That is a much more nuanced question that can only be answered by your team. |
[
{
"from": "human",
"value": "Hello, Im posting on behalf of my 76 year old father. He had double bypass surgery back in 1995. Other chronic conditions include Afib, medically managed cholesterol, and he is a regular drinker (mainly beer and wine). His medications include Metoprolol 50 mg, Xaralto, Lipitor 40 mg, Lavazo 4000 mg, baby Aspirin, Coq10, and D3. He has dealt with very swollen feet for years and always has a dry cough. He is not short of breath or wheezy at all. In fact he is quite active, he walks about 3-4x a week, lifts with a personal trainer 2x a week, does Pilates reformer once a week, and yoga/stretching lesson once a week. He has gone to Cleveland Clinic for a full physical every year and they feel that everything is managed from a cardiology perspective. They cannot treat his Afib via electric shock for whatever physiological reason, and he doesnt want to undergo a major surgery. According to his Apple Watch, his resting heart rate is 45 for the past 13 weeks. He had a vascular doppler of his lower extremities and they found that his veins are larger than normal but no blockages. His lab work has not shown signs of kidney problems. What is most concerning to me, is that no one ever seems to be concerned about his cough. My dad is convinced its allergies but he wont take an allergy pill because it makes him tired and wont see an allergist. I would love an opinion about his very swollen feet (picture below in comment) and persistent cough. I feel like it is abnormal and we shouldnt be taking everythings fine and managed for an acceptable answer. I think that it is a symptom of something else happening in his body. What do you think it could be and do you think he should go get a second opinion? If so, where?"
},
{
"from": "gpt",
"value": "Sounds like congestive heart failure. He should see a doctor asap."
}
] | Hello, Im posting on behalf of my 76 year old father. He had double bypass surgery back in 1995. Other chronic conditions include Afib, medically managed cholesterol, and he is a regular drinker (mainly beer and wine). His medications include Metoprolol 50 mg, Xaralto, Lipitor 40 mg, Lavazo 4000 mg, baby Aspirin, Coq10, and D3. He has dealt with very swollen feet for years and always has a dry cough. He is not short of breath or wheezy at all. In fact he is quite active, he walks about 3-4x a week, lifts with a personal trainer 2x a week, does Pilates reformer once a week, and yoga/stretching lesson once a week. He has gone to Cleveland Clinic for a full physical every year and they feel that everything is managed from a cardiology perspective. They cannot treat his Afib via electric shock for whatever physiological reason, and he doesnt want to undergo a major surgery. According to his Apple Watch, his resting heart rate is 45 for the past 13 weeks. He had a vascular doppler of his lower extremities and they found that his veins are larger than normal but no blockages. His lab work has not shown signs of kidney problems. What is most concerning to me, is that no one ever seems to be concerned about his cough. My dad is convinced its allergies but he wont take an allergy pill because it makes him tired and wont see an allergist. I would love an opinion about his very swollen feet (picture below in comment) and persistent cough. I feel like it is abnormal and we shouldnt be taking everythings fine and managed for an acceptable answer. I think that it is a symptom of something else happening in his body. What do you think it could be and do you think he should go get a second opinion? If so, where? | Sounds like congestive heart failure. He should see a doctor asap. |
[
{
"from": "human",
"value": "Left Ventricle: The ventricular size is normal. There is no left ventricular hypertrophy. Global LV systolic function is normal. The left ventricular ejection fraction is 70 %. LV diastolic filling parameters are c/w normal diastolic function.Right Ventricle: The right ventricular size is normal. Global RV systolic function is normal.Left Atrium: The left atrium is normal in size.Summary and Conclusions:No previous studies for comparison.Normal LV size and systolic function. LVEF= 70%. Normal LV filling pressures.Normal RV size and systolic function.Normal biatrial size.MEASUREMENTS AND CALCULATIONS:Left Ventricle: Normal Aorta/Left Atrium: Normal IVSd: 0.6 cm (0.7-1.1) LV FS: 40 % (>25%) RA Area A4C: 11.8 cm2 (<18) LV EF (Biplane) 70 %. (54-74) Right Ventricle: LV Mass 66 g (67-162) RVd A4C: 2.8 cm (2.5-4.2) LV RWT 0.40 (<0.43) TAPSE: 15 mm (>16) LV EDV 2D: 44.5 (56-155) IVC Diameter: 1.8 cm LV ESV 2D: 13.4 (19-58) LV EDV index: 31 ml/m2 (35-75) LV ESV index: 9 ml/m2 (12-30)"
},
{
"from": "gpt",
"value": "Cardiologists take a broad approach to reading an echocardiogram, not just looking to see what measurements fall within a range. Your cardiologist is the best person to tell you if your echo is normal or not.This is a normal study"
}
] | Left Ventricle: The ventricular size is normal. There is no left ventricular hypertrophy. Global LV systolic function is normal. The left ventricular ejection fraction is 70 %. LV diastolic filling parameters are c/w normal diastolic function.Right Ventricle: The right ventricular size is normal. Global RV systolic function is normal.Left Atrium: The left atrium is normal in size.Summary and Conclusions:No previous studies for comparison.Normal LV size and systolic function. LVEF= 70%. Normal LV filling pressures.Normal RV size and systolic function.Normal biatrial size.MEASUREMENTS AND CALCULATIONS:Left Ventricle: Normal Aorta/Left Atrium: Normal IVSd: 0.6 cm (0.7-1.1) LV FS: 40 % (>25%) RA Area A4C: 11.8 cm2 (<18) LV EF (Biplane) 70 %. (54-74) Right Ventricle: LV Mass 66 g (67-162) RVd A4C: 2.8 cm (2.5-4.2) LV RWT 0.40 (<0.43) TAPSE: 15 mm (>16) LV EDV 2D: 44.5 (56-155) IVC Diameter: 1.8 cm LV ESV 2D: 13.4 (19-58) LV EDV index: 31 ml/m2 (35-75) LV ESV index: 9 ml/m2 (12-30) | Cardiologists take a broad approach to reading an echocardiogram, not just looking to see what measurements fall within a range. Your cardiologist is the best person to tell you if your echo is normal or not.This is a normal study |
[
{
"from": "human",
"value": "Please can I have some help identifying exactly what material has caused a nasty skin reaction in my 5 yr old? (Female, Caucasian, no health issues but has had other topical reactions in past)She had a tonsillectomy a few days ago and her skin has reacted to the sponge backing on the electrodes they stuck to her chest during surgery. (I know it's only the sponges, as the welts are in perfect circles)I've identified the electrodes as Ambu WhiteSensor 4535M https://www.ambu.co.uk/cardiology/ecg-electrodes/product/ambu-whitesensor-4535mThe data sheet says the sponge is material is \"polyester polyurethane reticulated\". Google tells me these are two different materials? Is there a common name for this stuff that doctors use, and is it a common medical material that I need to look out for in future?"
},
{
"from": "gpt",
"value": "Acrylate allergy is most likely followed by nickel next."
}
] | Please can I have some help identifying exactly what material has caused a nasty skin reaction in my 5 yr old? (Female, Caucasian, no health issues but has had other topical reactions in past)She had a tonsillectomy a few days ago and her skin has reacted to the sponge backing on the electrodes they stuck to her chest during surgery. (I know it's only the sponges, as the welts are in perfect circles)I've identified the electrodes as Ambu WhiteSensor 4535M https://www.ambu.co.uk/cardiology/ecg-electrodes/product/ambu-whitesensor-4535mThe data sheet says the sponge is material is "polyester polyurethane reticulated". Google tells me these are two different materials? Is there a common name for this stuff that doctors use, and is it a common medical material that I need to look out for in future? | Acrylate allergy is most likely followed by nickel next. |
[
{
"from": "human",
"value": "65M, 5'9\", 140lbs, Asian / Chinese, NYC, no medications <-- My Dad's InfoI'm in a stressful medical situation right now, and need some help / advise. My dad had an emergency aortic valve and ascending aorta replacement 5 days ago due to aortic dissection 7 days ago. He was in the OR for ~11 hours because they first attempted to repair a part of the ascending aorta, took him off bypass, saw that things weren't going well, then put him back on bypass again to do a more aggressive procedure of replacing the aortic valve and the ascending aorta including the arch, so it was a very long amt of time on bypass.Yesterday he was moved from the Cardiothoracic ICU and into a normal hospital wing due to a bed shortage in the ICU. I've noticed since he came out of surgery that he has a facial muscular abnormality on his left side (his left mouth is slanted up) and is having difficulty speaking/writing (he is slow to utter syllables, is misspelling very easy English and Chinese words, can't pronounce English and Mandarin words to the point where it is not possible to have a conversation with him without both my mom and I guessing while he attempts to partially speak / write). The cardiology team told me yesterday that they don't think they need to bring neurology in to examine him because it may all be normal effects of the bypass. I am really worried there may be signs of a stroke (he can't read/write properly and his mouth is crooked) and I am wondering why nobody at my dad's hospital is concerned with a neuro eval. What do you think - should I push back more for a neuro eval or is this normal?"
},
{
"from": "gpt",
"value": "I'm a neurosurgeon so I'm kinda talking out of turn but....I did rotate thru CT surgery as an intern long ago, so maybe it's still valid.Have they done a CT or MRI of his brain? If yes and it's normal, rest easy. A negative imaging study (especially MRI) rules out a stroke, which means there's little for neurology to do, other than diagnose \"encephalopathy after surgery/bypass.\" However, if they've done no imaging, I'd consider that odd. My ICU has a low threshold to get a neurology consult and imaging, and someone having language issues and a facial droop for 5 days after heart surgery would certainly trigger it."
}
] | 65M, 5'9", 140lbs, Asian / Chinese, NYC, no medications <-- My Dad's InfoI'm in a stressful medical situation right now, and need some help / advise. My dad had an emergency aortic valve and ascending aorta replacement 5 days ago due to aortic dissection 7 days ago. He was in the OR for ~11 hours because they first attempted to repair a part of the ascending aorta, took him off bypass, saw that things weren't going well, then put him back on bypass again to do a more aggressive procedure of replacing the aortic valve and the ascending aorta including the arch, so it was a very long amt of time on bypass.Yesterday he was moved from the Cardiothoracic ICU and into a normal hospital wing due to a bed shortage in the ICU. I've noticed since he came out of surgery that he has a facial muscular abnormality on his left side (his left mouth is slanted up) and is having difficulty speaking/writing (he is slow to utter syllables, is misspelling very easy English and Chinese words, can't pronounce English and Mandarin words to the point where it is not possible to have a conversation with him without both my mom and I guessing while he attempts to partially speak / write). The cardiology team told me yesterday that they don't think they need to bring neurology in to examine him because it may all be normal effects of the bypass. I am really worried there may be signs of a stroke (he can't read/write properly and his mouth is crooked) and I am wondering why nobody at my dad's hospital is concerned with a neuro eval. What do you think - should I push back more for a neuro eval or is this normal? | I'm a neurosurgeon so I'm kinda talking out of turn but....I did rotate thru CT surgery as an intern long ago, so maybe it's still valid.Have they done a CT or MRI of his brain? If yes and it's normal, rest easy. A negative imaging study (especially MRI) rules out a stroke, which means there's little for neurology to do, other than diagnose "encephalopathy after surgery/bypass." However, if they've done no imaging, I'd consider that odd. My ICU has a low threshold to get a neurology consult and imaging, and someone having language issues and a facial droop for 5 days after heart surgery would certainly trigger it. |
[
{
"from": "human",
"value": "No, they have not done imaging of the brain yet. If this were your family member, would you advocate for CT or MRI? Thank you so much for replying to me so quckly."
},
{
"from": "gpt",
"value": "I think a CT is a reasonable step. Quick look to rule out something concerning like a bleed or a stroke."
}
] | No, they have not done imaging of the brain yet. If this were your family member, would you advocate for CT or MRI? Thank you so much for replying to me so quckly. | I think a CT is a reasonable step. Quick look to rule out something concerning like a bleed or a stroke. |
[
{
"from": "human",
"value": "Thank you so much for your help. Using info and confidence from this thread, I was able to push/advocate with the hospital over the last few days to have the surgeon finally order a CT scan and....blood clot in the frontal lobe. A stroke team then confirmed an embolic stroke immediately. He will need to have another procedure to remove fluid around the heart.It suprises me that if I had not pushed for brain imaging, my father would have been discharged as if nothing was wrong. I can see why having family/children may sometimes be the difference between good care and terrible care. It feels good to have a baseline data point and it sounds like aspirin + therapy are the only treatment that we can seek after his condition hopefully stabilizes (low blood oxygen levels, fluid in heart and lungs is in hard to reach places, etc.).The power of Reddit continues to shine. I am grateful for this community."
},
{
"from": "gpt",
"value": "Glad you pushed and got some answers. Heart surgery puts people at risk of both bleeding strokes (because the blood is thinned during surgery) and well as embolic strokes (because things can flick off arteries, valves, and even repair devices like aortic repair grafts). It's important to differentiate between the two, since a bleeding stroke is a contraindication to many/most post op blood thinners.I hope your dad's recovery goes smoothly. He might ultimately be a candidate for inpatient rehab, which can definitely accelerate recovery after a stroke. It's usually done at a different facility than where the surgery was done. The physical, occupational and speech therapists that work with him now will let you and the surgeon know if he's an appropriate candidate for it."
}
] | Thank you so much for your help. Using info and confidence from this thread, I was able to push/advocate with the hospital over the last few days to have the surgeon finally order a CT scan and....blood clot in the frontal lobe. A stroke team then confirmed an embolic stroke immediately. He will need to have another procedure to remove fluid around the heart.It suprises me that if I had not pushed for brain imaging, my father would have been discharged as if nothing was wrong. I can see why having family/children may sometimes be the difference between good care and terrible care. It feels good to have a baseline data point and it sounds like aspirin + therapy are the only treatment that we can seek after his condition hopefully stabilizes (low blood oxygen levels, fluid in heart and lungs is in hard to reach places, etc.).The power of Reddit continues to shine. I am grateful for this community. | Glad you pushed and got some answers. Heart surgery puts people at risk of both bleeding strokes (because the blood is thinned during surgery) and well as embolic strokes (because things can flick off arteries, valves, and even repair devices like aortic repair grafts). It's important to differentiate between the two, since a bleeding stroke is a contraindication to many/most post op blood thinners.I hope your dad's recovery goes smoothly. He might ultimately be a candidate for inpatient rehab, which can definitely accelerate recovery after a stroke. It's usually done at a different facility than where the surgery was done. The physical, occupational and speech therapists that work with him now will let you and the surgeon know if he's an appropriate candidate for it. |
[
{
"from": "human",
"value": "Female 35 / 55 / 195 poundsI attended my physical today and my doctor said that I have a heart murmur. This hasnt ever happened to me. She told me not to worry but now I have a cardiology appointment. I have severe health anxiety. She said its likely from anxiety or a small leak? - she said since I dont get out of breath its unlikely its serous?"
},
{
"from": "gpt",
"value": "Everyone here will tell you the same thing your doctor told you.Take a deep breath, Relax and wait for the next appointment. No one can tell you any different without examining you."
}
] | Female 35 / 55 / 195 poundsI attended my physical today and my doctor said that I have a heart murmur. This hasnt ever happened to me. She told me not to worry but now I have a cardiology appointment. I have severe health anxiety. She said its likely from anxiety or a small leak? - she said since I dont get out of breath its unlikely its serous? | Everyone here will tell you the same thing your doctor told you.Take a deep breath, Relax and wait for the next appointment. No one can tell you any different without examining you. |
[
{
"from": "human",
"value": "Sex - FemaleLocation - EnglandPre-existing conditions - Chiari Malformation with Syrinx, IIHSurgeries in previous 12 months - Stents fitted to transverse sinus & ICP monitorMedications - Aspirin, Antenolol, Acetazolamide and progesterone only pill (to stop cycles, I am sterilised so not used as birth control).Issue - Hi. I am currently waiting an appointment with cardiology following a trip to A&E with tightening pains in the chest when experiencing a double heart beat. This was evident on the ECG the hospital took and appeared similar to the ones taken with my Apple Watch. It has been queried if it may be bigeminy(?). Ive attached an image in the comments from today. The episodes are becoming more frequent and happening for longer periods. I dont want to bother our already busy hospitals when these happen just to have an ECG and be sent away to wait the referral. Can anyone suggest anything I can try to stop this happening? I dont drink given my pre-existing conditions, have never smoked and Ive cut out caffeine already with no results. Thank youETA - Ive taken blood pressure when these are happening and readings are totally normal, reading with picture in comments was 114/66"
},
{
"from": "gpt",
"value": "Looks like classic premature atrial contractions (PAC). Can happen in times of high stress. Usually benign, sometimes in the setting of new arrhythmia. Beta blockers can reduce occurrence so maybe cardiology might want to discuss atenolol dose.Sounds like you might getting into a cycle that precedes panic attacks which makes people feel like they are having a heart attack eg short of breath, chest pain. Then fear of a similar episode happening again causes stress and then you cycle right back into stress induced PACs. Breathing exercises are golden when you feel youre about to enter one of these cycles. In through the nose 4 seconds, out through the mouth for 6 seconds. Do this at least 4 times and focus on breathing.See what cardiology has to say. Very unlikely anything serious."
}
] | Sex - FemaleLocation - EnglandPre-existing conditions - Chiari Malformation with Syrinx, IIHSurgeries in previous 12 months - Stents fitted to transverse sinus & ICP monitorMedications - Aspirin, Antenolol, Acetazolamide and progesterone only pill (to stop cycles, I am sterilised so not used as birth control).Issue - Hi. I am currently waiting an appointment with cardiology following a trip to A&E with tightening pains in the chest when experiencing a double heart beat. This was evident on the ECG the hospital took and appeared similar to the ones taken with my Apple Watch. It has been queried if it may be bigeminy(?). Ive attached an image in the comments from today. The episodes are becoming more frequent and happening for longer periods. I dont want to bother our already busy hospitals when these happen just to have an ECG and be sent away to wait the referral. Can anyone suggest anything I can try to stop this happening? I dont drink given my pre-existing conditions, have never smoked and Ive cut out caffeine already with no results. Thank youETA - Ive taken blood pressure when these are happening and readings are totally normal, reading with picture in comments was 114/66 | Looks like classic premature atrial contractions (PAC). Can happen in times of high stress. Usually benign, sometimes in the setting of new arrhythmia. Beta blockers can reduce occurrence so maybe cardiology might want to discuss atenolol dose.Sounds like you might getting into a cycle that precedes panic attacks which makes people feel like they are having a heart attack eg short of breath, chest pain. Then fear of a similar episode happening again causes stress and then you cycle right back into stress induced PACs. Breathing exercises are golden when you feel youre about to enter one of these cycles. In through the nose 4 seconds, out through the mouth for 6 seconds. Do this at least 4 times and focus on breathing.See what cardiology has to say. Very unlikely anything serious. |
[
{
"from": "human",
"value": "22F. 115lbs. 5'2. History of gallbladder removal. History of lupus. I take aderall for ADHD and hydroxychloroquine for my lupus, as well as birth control.EDIT: Heres the full reportI saw a cardiologist a month ago and wore a heart monitor for 2 weeks and had an echo done. I went in because I have a consistently high heart. The heart monitor didn't show anything concerning according to cardiology and I was diagnosed with inappropriate sinus tachycardia. Well, I got my report back.Everything was normal besides two things that I read on the report:Trace mitral valve regurgitation.IVC is dilated at 2.5 cm.This freaks me out a bit because my doctor didn't mention any of this to me and he won't respond. On the 2D measurements, the only abnormal measurement was my LA which was 2.8 (reference range 3.0-4.0 cm).The reports from the mitral valve stated:Regurgitation: TracePeak E: 0.9 (0.6-1.3 m/s)Peak A: 0.5 (<0.7 m/s)E/A Ratio: 1.8 (0.75-1.5)The only other measurements that were high were my Pulmonic Valve:Peak Vel: 1.1 (0.6-0.9 m/s)Peak Grad: 4.5 (<=3 mmHg)I am really freaking out. How concerning is this? Is the dilation, regurgitation, and high values concerning?"
},
{
"from": "gpt",
"value": "A lot of good answers here, I'll just confirm what the others have said. Pretty much all the answers I read are correct. It's not uncommon for our heart valves to have a tiny bit of leak (regurgitation), it's nothing to worry about. As far as the IVC. It's a touch on the large side but it could just be a normal variant. It could also mean that you are very well hydrated and there just happens to be a lot of fluid in your veins making it look nice and plump."
}
] | 22F. 115lbs. 5'2. History of gallbladder removal. History of lupus. I take aderall for ADHD and hydroxychloroquine for my lupus, as well as birth control.EDIT: Heres the full reportI saw a cardiologist a month ago and wore a heart monitor for 2 weeks and had an echo done. I went in because I have a consistently high heart. The heart monitor didn't show anything concerning according to cardiology and I was diagnosed with inappropriate sinus tachycardia. Well, I got my report back.Everything was normal besides two things that I read on the report:Trace mitral valve regurgitation.IVC is dilated at 2.5 cm.This freaks me out a bit because my doctor didn't mention any of this to me and he won't respond. On the 2D measurements, the only abnormal measurement was my LA which was 2.8 (reference range 3.0-4.0 cm).The reports from the mitral valve stated:Regurgitation: TracePeak E: 0.9 (0.6-1.3 m/s)Peak A: 0.5 (<0.7 m/s)E/A Ratio: 1.8 (0.75-1.5)The only other measurements that were high were my Pulmonic Valve:Peak Vel: 1.1 (0.6-0.9 m/s)Peak Grad: 4.5 (<=3 mmHg)I am really freaking out. How concerning is this? Is the dilation, regurgitation, and high values concerning? | A lot of good answers here, I'll just confirm what the others have said. Pretty much all the answers I read are correct. It's not uncommon for our heart valves to have a tiny bit of leak (regurgitation), it's nothing to worry about. As far as the IVC. It's a touch on the large side but it could just be a normal variant. It could also mean that you are very well hydrated and there just happens to be a lot of fluid in your veins making it look nice and plump. |
[
{
"from": "human",
"value": "Thank you so very much for this. It is very much appreciated. I had assumed that my doctor wouldve told me if it was concerning but I just wanted to double check. I do have very plump veins which makes blood work easy for me lol.The hydration would make sense as I hound down so much water throughout the day (close to 90 oz). I was over hydrating too much and ended up depleting my electrolytes so now I add electrolyte drops to my water.Again, thank you so much for taking the time to respond and fantastic username."
},
{
"from": "gpt",
"value": "I'd interpret this as basically not concerning. IVC of 2.5cm by itself can be normal in adults as long as there's good compressibility and respirophasic variation (not commented on, but given lack of tricuspid regurgitation and normal right heart function, would highly doubt any abnormalities). Most likely, this just means you were well hydrated at the time of the study.Regarding the mitral regurgitation, trace amounts of regurgitation across the mitral and tricuspid valves can occur in otherwise healthy adults without any significant pathology or cause for concern. Given that the rest of the report shows normal systolic and diastolic function, I'd be really surprised if the regurgitation they describe is significant or would cause any symptoms."
}
] | Thank you so very much for this. It is very much appreciated. I had assumed that my doctor wouldve told me if it was concerning but I just wanted to double check. I do have very plump veins which makes blood work easy for me lol.The hydration would make sense as I hound down so much water throughout the day (close to 90 oz). I was over hydrating too much and ended up depleting my electrolytes so now I add electrolyte drops to my water.Again, thank you so much for taking the time to respond and fantastic username. | I'd interpret this as basically not concerning. IVC of 2.5cm by itself can be normal in adults as long as there's good compressibility and respirophasic variation (not commented on, but given lack of tricuspid regurgitation and normal right heart function, would highly doubt any abnormalities). Most likely, this just means you were well hydrated at the time of the study.Regarding the mitral regurgitation, trace amounts of regurgitation across the mitral and tricuspid valves can occur in otherwise healthy adults without any significant pathology or cause for concern. Given that the rest of the report shows normal systolic and diastolic function, I'd be really surprised if the regurgitation they describe is significant or would cause any symptoms. |
[
{
"from": "human",
"value": "My (74F) mom will likely be diagnosed with Alzheimer's later this month by the neurologist when we go for a follow-up after an inpatient stay for delirium. She is currently in a memory care facility. She has DM, OSA, and CHF with an implanted defibrillator. As I step in to manage her appointments I was wondering if she needs to see all her various specialists still. She will be seen by a Geriatrician for primary care, and I assume Cardiology would still be needed due to the defibrillator. But would she still need endocrinology and a dietician for the DM? What about Neurology and Psychiatry after the diagnosis? I got the impression from the Hospitalist that no treatment would be coming for Alzheimer's. Her DM and OSA have always been poorly controlled due to her non-compliance. I don't want her to get worse, but I'm also wanting to be as efficient as possible with the appointments since I'm on my own."
},
{
"from": "gpt",
"value": "When quality of life starts to decline, it is important to look at quality vs. quantity of life. If you want her to live as long as possible then yes she needs to continue to see her specialists unless they say it isn't necessary.If her goals are just peace, dignity and comfort rather than trying to extend life then focus on this instead. Her geriatrician can help with this."
}
] | My (74F) mom will likely be diagnosed with Alzheimer's later this month by the neurologist when we go for a follow-up after an inpatient stay for delirium. She is currently in a memory care facility. She has DM, OSA, and CHF with an implanted defibrillator. As I step in to manage her appointments I was wondering if she needs to see all her various specialists still. She will be seen by a Geriatrician for primary care, and I assume Cardiology would still be needed due to the defibrillator. But would she still need endocrinology and a dietician for the DM? What about Neurology and Psychiatry after the diagnosis? I got the impression from the Hospitalist that no treatment would be coming for Alzheimer's. Her DM and OSA have always been poorly controlled due to her non-compliance. I don't want her to get worse, but I'm also wanting to be as efficient as possible with the appointments since I'm on my own. | When quality of life starts to decline, it is important to look at quality vs. quantity of life. If you want her to live as long as possible then yes she needs to continue to see her specialists unless they say it isn't necessary.If her goals are just peace, dignity and comfort rather than trying to extend life then focus on this instead. Her geriatrician can help with this. |
[
{
"from": "human",
"value": "I have pasted the findings of my regular echo below (The tricuspid regurgitation is new) I apologize for the formatting. It wouldnt allow photos.I am a 31 y/o female and just had my yearly follow-up with cardiology. Suddenly my doctor says she is very concerned about my MVP due to my age, and scheduled the esophageal echo.Naturally, I am terrified. I have a four year old, and Im supposed to be getting married. I have issues with anesthesia and Ive been a mess at work all day at the thought of having heart surgery - or possibly not waking up.How serious DOES this sound? I believe a doctor when they say theyre concerned. But Im freaking out right now. Normal left ventricular size and systolic function with an estimated EF 55%. Mild left atrial enlargement. The mitral valve is thickened and the anterior mitral valve leaflet is elongated. There is bileaflet mitral valve prolapse and an associated eccentric jet of moderate mitral insufficiency. There is mild tricuspid valve regurgitation. Dilated IVC without respiratory variation consistent with elevated right atrial pressure 15 mmHg. Estimated PA systolic pressure at the upper limits of normal 34 mmHg. Given decline in LV systolic function (previously 65%) and technically difficult images with difficult to view mitral insufficiency, will discuss with the patient moving forward with a TEE.-Left ventricle cavity size appears normal. Left ventricular systolic function is normal with an ejection fraction of 55%.-Left atrium cavity size is mildly dilated.-Right ventricle cavity size appears normal. -Systolic function is normal.-Right atrium cavity size is normal.-The aortic valve is probably tricuspid. The leaflets exhibit normal excursion. There is no regurgitation.-The mitral valve is thickened and the anterior mitral valve leaflet is elongated. There is bileaflet mitral valve prolapse and an associated eccentric jet of moderate mitral insufficiency.-There is mild tricuspid regurgitation. RVSP is 34 mmHg.-The pulmonic valve was not well visualized.-The aortic root at the Sinuses of Valsalva appears normal in size.-The inferior vena cava demonstrates a diameter of >21 mm and collapses <50%; therefore, the right atrial pressure is estimated at 15 mmHg.-There is no pericardial effusion"
},
{
"from": "gpt",
"value": "Sounds like the initial problem here is that they can't get good enough images of your mitral valve, so that's why the doctor is suggesting the TEE (trans-esophageal echocardiogram). This will require sedation (usually moderate sedation, like getting your wisdom teeth out). This is a very safe procedure, so I'd suggest it as a good next step to get all the important information your doctor needs."
}
] | I have pasted the findings of my regular echo below (The tricuspid regurgitation is new) I apologize for the formatting. It wouldnt allow photos.I am a 31 y/o female and just had my yearly follow-up with cardiology. Suddenly my doctor says she is very concerned about my MVP due to my age, and scheduled the esophageal echo.Naturally, I am terrified. I have a four year old, and Im supposed to be getting married. I have issues with anesthesia and Ive been a mess at work all day at the thought of having heart surgery - or possibly not waking up.How serious DOES this sound? I believe a doctor when they say theyre concerned. But Im freaking out right now. Normal left ventricular size and systolic function with an estimated EF 55%. Mild left atrial enlargement. The mitral valve is thickened and the anterior mitral valve leaflet is elongated. There is bileaflet mitral valve prolapse and an associated eccentric jet of moderate mitral insufficiency. There is mild tricuspid valve regurgitation. Dilated IVC without respiratory variation consistent with elevated right atrial pressure 15 mmHg. Estimated PA systolic pressure at the upper limits of normal 34 mmHg. Given decline in LV systolic function (previously 65%) and technically difficult images with difficult to view mitral insufficiency, will discuss with the patient moving forward with a TEE.-Left ventricle cavity size appears normal. Left ventricular systolic function is normal with an ejection fraction of 55%.-Left atrium cavity size is mildly dilated.-Right ventricle cavity size appears normal. -Systolic function is normal.-Right atrium cavity size is normal.-The aortic valve is probably tricuspid. The leaflets exhibit normal excursion. There is no regurgitation.-The mitral valve is thickened and the anterior mitral valve leaflet is elongated. There is bileaflet mitral valve prolapse and an associated eccentric jet of moderate mitral insufficiency.-There is mild tricuspid regurgitation. RVSP is 34 mmHg.-The pulmonic valve was not well visualized.-The aortic root at the Sinuses of Valsalva appears normal in size.-The inferior vena cava demonstrates a diameter of >21 mm and collapses <50%; therefore, the right atrial pressure is estimated at 15 mmHg.-There is no pericardial effusion | Sounds like the initial problem here is that they can't get good enough images of your mitral valve, so that's why the doctor is suggesting the TEE (trans-esophageal echocardiogram). This will require sedation (usually moderate sedation, like getting your wisdom teeth out). This is a very safe procedure, so I'd suggest it as a good next step to get all the important information your doctor needs. |
[
{
"from": "human",
"value": "3f 3ft tall 34lbs No medications Medical history: Uncomplicated pregnancy and no complications during delivery (vaginal) VSD and heart murmur present at birth but resolved on its own and was cleared by cardiology at age 2 She does have sensory issues and possibly autism were awaiting evaluation.We play doctor a lot because going to the Dr has always been something shes had a hard time with and when I was checking her mouth I noticed she had some red dots on the inside of her cheeks. While I dont believe it to be anything worrisome I wanted to just check. I got the best pictures I could of the red dots I saw. Theres a single one on one side and about 6 on the other side. I tried asking her if anything hurt like her mouth or throat but she didnt respond and is not always able to communicate clearlyI just noticed it today, so I am unsure about the duration and how long its actually been there."
},
{
"from": "gpt",
"value": "Likely from normal trauma"
}
] | 3f 3ft tall 34lbs No medications Medical history: Uncomplicated pregnancy and no complications during delivery (vaginal) VSD and heart murmur present at birth but resolved on its own and was cleared by cardiology at age 2 She does have sensory issues and possibly autism were awaiting evaluation.We play doctor a lot because going to the Dr has always been something shes had a hard time with and when I was checking her mouth I noticed she had some red dots on the inside of her cheeks. While I dont believe it to be anything worrisome I wanted to just check. I got the best pictures I could of the red dots I saw. Theres a single one on one side and about 6 on the other side. I tried asking her if anything hurt like her mouth or throat but she didnt respond and is not always able to communicate clearlyI just noticed it today, so I am unsure about the duration and how long its actually been there. | Likely from normal trauma |
[
{
"from": "human",
"value": "42F, obese, hypertensive but controlled on meds, normal cholesterol but low HDL, arthritis, recent ankle reconstruction (July and October), seasonal allergies, depression/anxiety.Following a bout of awful GI issues for a week in December, I developed noticeable PVCs. They have progressively gotten more frequent, so I saw my PCP in January. She referred me to cardiology following a normal CBC and MBP.I had a two-day chemical stress test and echocardiogram yesterday and today. I finished around 0900 today and by 1330 I was scheduled for an emergency heart cath tomorrow.I never spoke to the cardiologist, only his nurse. She said he was incredibly concerned about the results of my tests, but didnt elaborate. I was in shock and didnt even think to ask why he was concerned.The results were uploaded to the My Chart app and I tried to read them, but its all foreign to me.Lexiscan reportEcho reportWould anyone be willing to help me understand this?"
},
{
"from": "gpt",
"value": "The reversible defect on the \"lexiscan report\" is showing that after injection of a drug to simulate the effects of exercise on your heart, there is an area of the heart that doesn't appear to be getting enough blood flow. The concern would be that there is a narrowed coronary artery in this area.These findings are not always accurate but warrant a coronary angiogram, where a small thin tube is threaded up into an artery usually in the wrist, to get a better look at the blood vessels and find if there is narrowing. If there is coronary artery disease, the options would be medical management, a cardiac stent, or recommendations for surgery.I'm reassured that you seem to have normal heart function and currently have no symptoms, and don't have diabetes which can cause some difficult-to-treat coronary lesions. \"Incredibly concerned\" is an unfortunate word choice, positive stress tests are a very frequent occurrence and you are stable. Don't get ahead of yourself you will know more after the cath about whether there is a problem and what to do about it."
}
] | 42F, obese, hypertensive but controlled on meds, normal cholesterol but low HDL, arthritis, recent ankle reconstruction (July and October), seasonal allergies, depression/anxiety.Following a bout of awful GI issues for a week in December, I developed noticeable PVCs. They have progressively gotten more frequent, so I saw my PCP in January. She referred me to cardiology following a normal CBC and MBP.I had a two-day chemical stress test and echocardiogram yesterday and today. I finished around 0900 today and by 1330 I was scheduled for an emergency heart cath tomorrow.I never spoke to the cardiologist, only his nurse. She said he was incredibly concerned about the results of my tests, but didnt elaborate. I was in shock and didnt even think to ask why he was concerned.The results were uploaded to the My Chart app and I tried to read them, but its all foreign to me.Lexiscan reportEcho reportWould anyone be willing to help me understand this? | The reversible defect on the "lexiscan report" is showing that after injection of a drug to simulate the effects of exercise on your heart, there is an area of the heart that doesn't appear to be getting enough blood flow. The concern would be that there is a narrowed coronary artery in this area.These findings are not always accurate but warrant a coronary angiogram, where a small thin tube is threaded up into an artery usually in the wrist, to get a better look at the blood vessels and find if there is narrowing. If there is coronary artery disease, the options would be medical management, a cardiac stent, or recommendations for surgery.I'm reassured that you seem to have normal heart function and currently have no symptoms, and don't have diabetes which can cause some difficult-to-treat coronary lesions. "Incredibly concerned" is an unfortunate word choice, positive stress tests are a very frequent occurrence and you are stable. Don't get ahead of yourself you will know more after the cath about whether there is a problem and what to do about it. |
[
{
"from": "human",
"value": "31M,169cm,95kgI want to ask. previously I had taken aspirin and clopidogrel as instructed by the cardiology clinic. at the same time I had an appointment with a gastroenterologist because of a stomach acid problem and the gastro doctor told me to stop Clopidogrel. When I take Aspirin and Clopidogrel Blood test like Red blood cell Hemoglobin Haematocrit is high and it was abnormal last month. My question, If I stop clopidogrel on the instructions of the gastro doctor will it cause 3 types of blood readings to increase more in the future"
},
{
"from": "gpt",
"value": "Clopidogrel and aspirin do not affect your red blood cell or hematocrit that being said you should speak with your cardiologist before stopping those medications"
}
] | 31M,169cm,95kgI want to ask. previously I had taken aspirin and clopidogrel as instructed by the cardiology clinic. at the same time I had an appointment with a gastroenterologist because of a stomach acid problem and the gastro doctor told me to stop Clopidogrel. When I take Aspirin and Clopidogrel Blood test like Red blood cell Hemoglobin Haematocrit is high and it was abnormal last month. My question, If I stop clopidogrel on the instructions of the gastro doctor will it cause 3 types of blood readings to increase more in the future | Clopidogrel and aspirin do not affect your red blood cell or hematocrit that being said you should speak with your cardiologist before stopping those medications |
[
{
"from": "human",
"value": "40/F 5'7 175 lbs: gerd, anxiety, bile reflux, asthma, allergies. Cardiology concerns- calcium score of 149, ldl 191, total cholesterol 281, family history of heart disease at a young age.My cardiologist just prescribed Rosuvastatin 40mg. The bottle says not to take within 2 hours of magnesium or aluminum antacids. Does that include esomeprazole magnesium? I usually take all my morning medications (esomeprazole, zyrtec, fluoxetine, vitamins) together- do I need to wait 2 hrs to take the statin?"
},
{
"from": "gpt",
"value": "No your esomeprazole should be fine"
}
] | 40/F 5'7 175 lbs: gerd, anxiety, bile reflux, asthma, allergies. Cardiology concerns- calcium score of 149, ldl 191, total cholesterol 281, family history of heart disease at a young age.My cardiologist just prescribed Rosuvastatin 40mg. The bottle says not to take within 2 hours of magnesium or aluminum antacids. Does that include esomeprazole magnesium? I usually take all my morning medications (esomeprazole, zyrtec, fluoxetine, vitamins) together- do I need to wait 2 hrs to take the statin? | No your esomeprazole should be fine |
[
{
"from": "human",
"value": "My father was in his late 40s and went on a walk. He was 160 lbs and 54 and vegetarian, didnt drink or smoke, and exercised pretty regularly. He called my mom and told her he couldnt breathe. She drove to him and got there within two minutes (he wasnt too far from our house). When she got there he was unresponsive and another passerby had started cpr and called 911. He revived before the paramedics got there and was able to talk to my mom. He even called her on the way to the hospital in the ambulance and told her he got there. As soon as he got there he lost his pulse. They did cpr on him and tried to revive him for an hour before they called his death. Im very lost. How could he have been revived on the sidewalk but not in the hospital. I thought cardiac events were treatable if they were caught within the first few minutes. He had calcium deposits on his heart and had tested positive for covid two weeks prior. Any insight would be greatly appreciated as Im looking for some understanding and closure.Edit: thank you all for your comments. Ive read all of them and really appreciate the insights you all have given into what could have happened. Im talking to a doctor about getting a cardiology consult for my siblings and I to make sure there arent genetic/other issues. Im also making sure my family will get the updated covid booster shots. My dad was pretty religious and we therefore cremated him as soon as possible, because thats what he would have wanted, and tbh I value fulfilling his last wishes more than an autopsy at this time. Ive also gotten my mom and siblings into grief counseling and am looking into options myself. Thank you again for all your kind words."
},
{
"from": "gpt",
"value": "Hi. I am very sorry for your loss.Some cardiac arrest cases do happen in healthier individuals and can be fatal. Not all cardiac arrest cases are treatable even in an emergency.It's normal to feel lost right now, but you will get through this. Grief counseling may be helpful in your situation for closure."
}
] | My father was in his late 40s and went on a walk. He was 160 lbs and 54 and vegetarian, didnt drink or smoke, and exercised pretty regularly. He called my mom and told her he couldnt breathe. She drove to him and got there within two minutes (he wasnt too far from our house). When she got there he was unresponsive and another passerby had started cpr and called 911. He revived before the paramedics got there and was able to talk to my mom. He even called her on the way to the hospital in the ambulance and told her he got there. As soon as he got there he lost his pulse. They did cpr on him and tried to revive him for an hour before they called his death. Im very lost. How could he have been revived on the sidewalk but not in the hospital. I thought cardiac events were treatable if they were caught within the first few minutes. He had calcium deposits on his heart and had tested positive for covid two weeks prior. Any insight would be greatly appreciated as Im looking for some understanding and closure.Edit: thank you all for your comments. Ive read all of them and really appreciate the insights you all have given into what could have happened. Im talking to a doctor about getting a cardiology consult for my siblings and I to make sure there arent genetic/other issues. Im also making sure my family will get the updated covid booster shots. My dad was pretty religious and we therefore cremated him as soon as possible, because thats what he would have wanted, and tbh I value fulfilling his last wishes more than an autopsy at this time. Ive also gotten my mom and siblings into grief counseling and am looking into options myself. Thank you again for all your kind words. | Hi. I am very sorry for your loss.Some cardiac arrest cases do happen in healthier individuals and can be fatal. Not all cardiac arrest cases are treatable even in an emergency.It's normal to feel lost right now, but you will get through this. Grief counseling may be helpful in your situation for closure. |
[
{
"from": "human",
"value": "OP, Im NAD but my dad passed suddenly and unexpectedly from cardiac arrest 10 months ago as well. He was 66, and had received a clean bill of health from his doctor 2 weeks prior. I just want to say, I am so incredibly sorry for your loss. I know how youre feeling. Grief is such an incredibly tough journey, one that Im still in. The first few months are the hardest, I got into grief counseling immediately and talking about my dad to someone really helped me. Just know that everything youre feeling is ok, and its good to ask questions. My thoughts are with you and your family.sacca:OP, I'm NAD, but as a hospice volunteer, many hospice organizations offer grief counseling services even if the person was not involved in their hospice program. These sorts of orgainzations might be a place to start for grief counseling.Grief is different for everyone, and for many it's like a roller coaster that eventually levels out, but the ride is uncomparable to anyone elses - give yourself time and space especailly now. I lost both my parents a little suddenly (they were in their 80s, but not much warning) and for me, years later, the roller coaster has become much flatter, with more tender memories than anything else.Another person: Adding to the story chain for OP.When I was 27, I had a massive widow maker heart attack in my larger artery (LAD). I was only 27.I didn't know I had a blood clot in my heart, because I didn't know I had a clotting disorder. The LAD was 98% clotted. Sometimes there's more silent things happening in our bodies.I'm really sorry for your loss OP."
},
{
"from": "gpt",
"value": "Im sorry for your loss. Without an autopsy or knowing your family history its impossible to know. He could have had a pulmonary embolism or myocarditis leading to ventricular arrhythmia as a result of his COVID. He could have a genetic syndrome such as Brugada or ARVC or the like. He could have suffered a massive heart attack though thats probably least likely."
}
] | OP, Im NAD but my dad passed suddenly and unexpectedly from cardiac arrest 10 months ago as well. He was 66, and had received a clean bill of health from his doctor 2 weeks prior. I just want to say, I am so incredibly sorry for your loss. I know how youre feeling. Grief is such an incredibly tough journey, one that Im still in. The first few months are the hardest, I got into grief counseling immediately and talking about my dad to someone really helped me. Just know that everything youre feeling is ok, and its good to ask questions. My thoughts are with you and your family.sacca:OP, I'm NAD, but as a hospice volunteer, many hospice organizations offer grief counseling services even if the person was not involved in their hospice program. These sorts of orgainzations might be a place to start for grief counseling.Grief is different for everyone, and for many it's like a roller coaster that eventually levels out, but the ride is uncomparable to anyone elses - give yourself time and space especailly now. I lost both my parents a little suddenly (they were in their 80s, but not much warning) and for me, years later, the roller coaster has become much flatter, with more tender memories than anything else.Another person: Adding to the story chain for OP.When I was 27, I had a massive widow maker heart attack in my larger artery (LAD). I was only 27.I didn't know I had a blood clot in my heart, because I didn't know I had a clotting disorder. The LAD was 98% clotted. Sometimes there's more silent things happening in our bodies.I'm really sorry for your loss OP. | Im sorry for your loss. Without an autopsy or knowing your family history its impossible to know. He could have had a pulmonary embolism or myocarditis leading to ventricular arrhythmia as a result of his COVID. He could have a genetic syndrome such as Brugada or ARVC or the like. He could have suffered a massive heart attack though thats probably least likely. |
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