Jeremiah M. Gelles

I disagree that it is not bad enough to go to the hospital. Your vital signs need to be taken during an episode. A careful history must be taken. What time of day does this occur? What are you doing? What did you have to eat the day it happened? What have you had to drink? What GI problems do you have? Are they the ones that might cause a vaso-vagal episode? You have to be examined by a doctor, preferably during an episode. You may need a variety of tests. This is a very nonspecific symptom and has many possible causes, some benign and some more serious.

This sounds musculoskeletal to me. I suggest seeing a sports medicine specialist. They may refer you for physical therapy. They might also consider sending you to a neurologist if they think this might be a pinched nerve or something similar. It does not sound life-threatening.

First and foremost, you need to see a health care provider, such as a physician to have your heart checked to see if anything is wrong with it and if it is not beating normal. If everything is ok when you get checked, see if someone can get hold of the records of the nurse (hopefully she documented her findings). Once we ascertain a problem, we would have to determine whether that problem could have been caused by the beating you took. So, much must be done before we can see what kind of recourse you have towards those who inflicted this punishment on you. That would be determined by a lawyer, not a doctor.

I cant read what you posted. The images are too blurry. Sorry. You need to include the images so that I can read them.

Yes. Right ventricular failure results primarily in fluid in the pleural cavities, the virtual space between the visceral pleura, directly lining the lungs, and the parietal pleura, lining the chest wall. Left ventricular failure is what causes fluid directly in the lungs. Usually, right ventricular failure is a result of left ventricular failure but not always. If you have fluid in the pleural space, you will generally have congestion of the liver, dilated veins in your neck, and swelling of the legs. You can even have fluid in the abdominal cavity causing swelling of the abdomen in severe right ventricular failure. Sometimes, right ventricular failure relieves a failing left ventricle so that there is less or very little fluid in the lungs. Pleural fluid can have many causes and you must be evaluated and treated by a doctor for it. This is a complicated condition!

Is the pain related to movement or position of the shoulder? If so, it is very unlikely to be cardiac in origin. If it is related to exertion and relieved by rest, then it might be cardiac. (I am not talking about exertion with the shoulder.) Your doctor should check you. In any case, at your age, a cardiac evaluation by your doctor would be a good idea.

Take the metoprolol now and resume taking it tomorrow morning. Take the atorvastatin tomorrow at any time and in the future at any time daily.

Without knowing anything more about your medical history, it is impossible to be 100% certain. If you dont smoke and are premenopausal and have not suffered from uncontrolled blood pressure for years, a very bad lipid profile or diabetes, or a family history of premature coronary disease, it is very unlikely. To be sure, you would have to go to an emergency room or urgent care center and have an EKG and blood test.

Avoid smoking, foods high in saturated fat, and stressful activities. Avoid the things that got you here in the first place and adopt a healthy lifestyle. As for immediate post-operative activities, your practitioner should advise you on that.

Many canned beverages like V8, for example, have a lot of salt. You must look at labels and see how much sodium is in anything you eat or drink. Other than that, the main thing you need to do is adhere to a healthy diet. Examples are the Mediterranean diet and the DASH diet. There is a lot of controversy about alcoholic beverages. Try to limit the intake of alcoholic drinks. I cant quantitate this recommendation. Some people would say no alcohol. I would say as little as possible, consistent with a relaxed life.

Take your blood pressure every morning while you relax, say at the breakfast table. I hope you eat a hearty breakfast with lots of high-fiber foods. Limit your daily salt intake. Try to optimize your weight and exercise regularly. A good walk, say 2-3 miles, is good exercise, so you dont have to swim 100 laps, climb a mountain, or run a marathon! If your blood pressure is consistently under 120, you can start modifying your BP med(s). If you take more than one daily, ask your doctor which one you can try stopping. Then, see what happens to your morning BP. If it exceeds 140, you must resume what you took. If you only take one pressure med, then try reducing the dose. Once again, see what happens to your pressure. If it goes up over 140, resume your previous dose. A couple of things you must get out of your mind. One is that taking medications is bad, and you should do everything possible to get off them. The other is that taking medications means that something is wrong with you. You should be thankful we have these lifesaving medications that help prevent strokes, heart attacks, and peripheral vascular disease. Please inform the prescribing physician of what I have written and what you do. I am not a substitute for your doctor!

A lot depends on whether you have any other conditions and how old you are. If hypertension is your only problem and it is systolic, diastolic, or both, I would start with a calcium channel blocker like amlodipine or an angiotensin receptor blocker, most likely losartan or valsartan, but there are six others: candesartan, irbesartan, telmisartan, Olmesartan, azilsartan, and eprosartan. Adding a thiazide diuretic would be next, although I might add a thiazide right from the start in some patients. Treating hypertension is one of the arts of medicine. It involves finding a combination of meds that is efficacious and reasonably well-tolerated. It involves trying as much as possible to get the patient to modify their eating habits and lifestyle to minimize stress (very difficult in the USA), and get more exercise and relaxation.

First, they must be diagnosed. That usually involves wearing a monitor for up to a month, depending on how often they occur unless you are lucky enough to have an EKG while you are having the palps.

This depends on the nature of your heart attack. Your cardiologist and/or primary caregiver knows this and should give you advice on exercise, diet, meds, and lifestyle.

Probably never. Alcohol is toxic to the heart, liver, muscles, and brain. In moderation, we normal people get away with it, but for someone with a heart transplant? Why take a chance! This is just my opinion, and I believe your friend should ask their transplant cardiologist.

Looks like a pretty normal echo. The comments about mildy sclerotic are hard to evaluate without actually seeing the images. Cardiologists read things differently. I doubt that this finding, if real, has anything to do with fen-phen, fenfluramine/phentermine.

Obviously you should see a doctor about this and get some tests if their history and physical exam does not suggest what I think is most likely that you strained a muscle or did something related to your musculoskeletal system. Thats what it sounds like to me. It does not sound like a heart attack but there are other possibilities as there always are when it comes to the human body and that is why you need to be examined.

I am assuming in my response that you are not a smoker and have not smoked for at least 15 years. I also am assuming that you are post menopausal but that your menopause was at a normal age. I am also assuming you do not have diabetes. Given all that there is no need for aspirin. I think if you can diet and exercise for a few months and check your lipid profile again, that would be a good idea. If your LDL remains significantly above 100 you can decide if you want to take a low dose of a statin. Probably 10mg of atorvastatin or rosuvastatin would get your LDL under 100 with no side effects. Thats what I would recommend but this is not an absolute recommendation. It is your decision. I am not sure what Vitamin k2 has to do with this. Lots of anti-oxidants are important and most women are advised to take Vit D3 and Calcium but that is also a matter to discuss with your doctor.

People can live to a ripe old age with aortic regurgitation. You do not report any symptoms of this condition the most common of which would be shortness of breath on exertion. The echo should indicate how severe the leak is. It should also indicate the size of your left ventricle which is being impacted by the back flow of some of the blood it is just ejected. This is a very complicated condition in terms of its physiology and prognosis and management. You will have to see a cardiologist and be followed by them. In any case we have excellent treatments for most valvular heart disease and this includes aortic regurgitation so relax and go about your life. Even if you need to have the valve replaced, you may be lucky and there may be a percutaneous valve replacement as there is for aortic stenosis, a narrowed aortic valve. I tell my patients to promise to tell me if they start feeling that their breath is short while doing activities they previously did with no trouble. Especially if this is beyond what they would expect from just the realities of growing older.

You seem very anxious. Taking your blood pressure so often will make you more anxious. Anxiety can cause a lot of your symptoms and blood pressure and heart rate findings. You will have to see a doctor and make sure there is nothing wrong more than anxiety. If not, then you will have to deal with what makes you so anxious. I have one caveat. Your medical history as reported here is very limited so I may have missed something important. That is why you have to see a thorough compassionate knowledgeable doctor.