Neda Buljubasic

Some types of skin rashes can be associated with a tingling or painful sensation over your skin. Consider consulting a dermatologist or your primary care physician for assessment and treatment.

A Bubble Study is an injection of agitated normal physiological solution into patient’s venous circulation in order to look for a shunt (a hole) between the right and left side of the heart.
If there is evidence of the shunt, meaning if bubbles cross from the right to the left side of the heart, that could explain why some people could have TIAs or strokes, by blood clots crossing through the hole inside their hearts.
If the shunt is large in size, and doctors believe that it is big enough to cause TIA or stroke, it could be closed via skin and peripheral veins by implanting a small occluder (a device) inside the heart, without a need to cut the chest open as we used to do it years ago.

Injecting bubbles is safe in patients who don’t have a very large holes in their hearts which can be diagnosed without injecting any “bubbles.” However, those smaller ones that can be easily missed without help of “bubbles” pose no risk to patients.

All stents require treatment with so called anti platelet medications (blood thinners, for example aspirin, clopidogrel, ticagrelor, prasugrel) to prevent clotting of the stent(s) after deployment. However, which type of the blood thinner, and their combination, as well as duration of the treatment depends on the type of the stent as well as patient’s medical history, their personal risks for bleeding complications or clotting complications.
Every patient has to receive strict blood thinner prescriptions by their cardiologist, including the duration for treatment and proper follow up in outpatient clinics after the procedure. Any significant bleeding complications or recurrent chest pain, shortness of breath, or their typical angina symptoms, should report promptly to the nearest ED.

Every patient is different from the stand point of complexity and severity of blockages in their heart arteries, whether they experienced any complications after stunting, any residual blockages that haven’t been stented or bypassed, any ongoing decreased blood supply to the heart muscle, whether the ste ting was associated with heart attack, what is patient’s pumping function of the heart, are there any other problems with the heart such as significant valve leaks or stenoses/obstructions, irregular heart beats, any complications at the site of the skin and blood vessel puncture, etc.
Therefore, every patient should receive clear guidance regarding exercise following coronary artery stenting, and frequently patients may need to have an exercise stress testing (walking on a treadmill), to provide the best exercise advice.

In general, patients should take it easy for a couple of weeks, engaging in a low level activities, such as walking on level terrain while staying away from heavy lifting. Then, gradually increase your activities, primarily through aerobic exercises.
You do need to have your cardiologists approval and guidance before you engage into any gym workouts, weight lifting, or other types of structured exercise.

Being on medications or having these symptoms should not interfere with vaccination. I would recommend getting vaccinated.

Patients with a high-grade blockage(es) in their heart vessels can experience various symptoms, especially with exertion, including easy fatiguability, dyspnea, chest discomfort, etc. Frequently, those symptoms can significantly improve or completely resolve with medical therapy and/or after fixing the blockage by opening up the vessel by deploying a coronary stent.

Some people may feel arrhythmia, however, some may not. There are different types of arrhythmia including slow or fast, regular or irregular, originating from the upper vs. lower chamber of the heart. Some arrhythmia could be associated with lightheadedness, dizziness, shortness of breath, chest discomfort, passing out or fainting. If you have any concerns or suspicion of having an arrhythmia, talk with your doctor. Your doctor may consider doing an electrocardiogram and ordering a hart monitor (Holter, ZioPatch, or an event recorder) to monitor your heart rhythm for extended time like days, weeks, or months. Your doctor can also discuss with you potential causes of arrhythmia and how to minimize the risk (ex., decreasing intake of cardiac stimulants such as caffeine, etc.), checking your thyroid hormones and electrolytes in a blood sample, reviewing your medications including over-the-counter medications, etc.

I am sorry to hear that you were laid off. Stress related to being laid off can definitely increase your blood pressure (BP).Good blood pressure control is considered if BP is no higher than 120/80 mmHg.If your blood pressure is persistently elevated you may need to be in BP medications if risk factor modifications are not sufficient in controlling hypertension, such as low salt diet (no added salt and avoiding salty foods), maintaining ideal body weight, if a person is overweight or obese, daily exercise (refrain from heavy lifting), control of diabetes, cholesterol control, treatment of possible obstructive sleep apnea, abstinence from tobacco use or any illicit drug use, etc. Meditation and relaxation techniques are helpful.Some medications including over-the-counter medications can contribute to high blood pressure as well. However, it would be important that you see your PCP to check the basic blood work up/urine analysis, assessment of other possible causes of high blood pressure (hormonal/metabolic or related to vascular/organ abnormalities) and kidney function.While undergoing work up for hypertension, your doctor may decide to put you on medication in order to prevent possible negative effects of high blood pressure such as  heart failure, irregular heart rhythm, heart attack/chest pain, stroke, headaches, kidney insufficiency/failure, aortic rupture, and many other potential problems. Keeping track of your daily BP’s and presenting it to your PCP, would be helpful.
I hope that you will find this information helpful. I also hope that you will be able to find a job very soon.  

Best of luck! 

Dr B. 

There could be several different types of “septal defects” in the heart. It depends where the defect is, how big it is, is it associated with other potential abnormalities in the heart, is it congenital (at birth) or is it acquired (occurs later in life). Many of these defects can close spontaneously throughout the life. However, the larger ones can persist. If a “septal defect” persists and it is large enough to cause significant left to right shunting which overwhelms the right side of the heart and lung circulation, it can cause high lung pressures and right sided heart failure. In addition, once lung pressures increase high enough it can start shunting blood in opposite direction, meaning from right to left, decreasing the flow and oxygenation through the lungs, now leading to a decrease of oxygen in a person’s circulation and tissues. This can cause bluish discoloration of skin, shortness of breath, fatigue and other symptoms. There are other potential risks of having a septal defect, including blood clot migration which could lead to stroke or infections. It can be easily diagnosed by heart ultrasound or CT scan or cardiac MRI. The degree of shunt and direction of the shunt can be measured. Sometimes, heart catheterization may need to be done to measure pressures inside heart chambers and lungs, and to determine the size of the defect. Based on patient’s symptoms, the size of the defect, lung pressures, it can be determine whether the defect should be closed or not. You should be referred to a cardiologist for a comprehensive evaluation.  
Good luck!

There are many different types of arrhythmia. Some are benign, and some can be life-threatening. It is very important to find out more about the the arrhythmia, what type it is, does it originate from the upper chamber(s) or the lower chamber of the heart, how symptomatic the patient is, what precipitated or triggers arrhythmia, and how easily It can be prevented or treated. Therefore, it is very important that you see and discuss this arrhythmia problem with a cardiologist or arrhythmia specialist to give you more insight into the arrhythmia, including treatment options.

Irregular heart beat or arrhythmia is never a normal thing. Some arrhythmia are more dangerous than others, but all of the arrhythmia can be life threatening.
Even seemingly more benign arrhythmia can result in heart failure and death if left untreated.
For these reasons, I would highly recommend that you do seek medical attention to see how to treat arrhythmia and what treatment would have minimal adverse effects. It is very important to look into causes of arrhythmia and potentially treat arrhythmia by eliminating the cause, or to minimize the risk of arrhythmia reoccurrence.

Heart murmurs can reflect a leaky valve or a tight valve in the heart. Therefore, they can vary in significance. It would be important to have a heart ultrasound done to look into what causes the heart murmur. To answer your question, it is not the murmur it self that is fatal, but a valve abnormality (tight or leaky) can overtime lead to a fatal outcome if left untreated.

No, you don’t need to worry about “rejecting” a pacemaker. The pacemaker shell is made of inert stainless steel so body does not mount immune response to it. Infection is a rare reason that pacemaker has to be taken out. You need to have regular follow-up visits with a pacemaker clinic to make sure your pacemaker is doing the job that it is expected to do, that the battery life is sufficient, and sometimes it may need to be reprogrammed. Newer pacemakers can be monitored remotely over the phone.

He has to be worked up by medical professionals, definitely by a heart specialist (cardiologist), to see what could have been an underlying cause of the arrest and how it can be prevented in the future.