Mohamad S. Kassir

First of all, you need to know if you indeed had pneumonia originally and had the usual symptoms like fever, cough, yellow sputum, shortness of breath, and you had elevated WBC on a blood test. Very important is a chest X-ray correlated with the pneumonia and, if sputum and/or blood cultures showed that certain bacteria suspected of causing the pneumonia, it allows the appropriate choice of antibiotics treatment and the length of treatment.

If patient's condition did improve, but never resolved, then we need to suspect one of the following:
-The condition became complicated by fluid around the lung (EFFUSION), and if lot presents then draining with simple procedure something needed if medications are not working. Special X-ray may become necessary if routine X-ray remains abnormal. CT scan of the chest is needed if the chest X-ray continues to show suspension of pneumonia after appropriate treatment.

-Congestive heart failure sometimes can be misdiagnosed as pneumonia, especially if fluids around the right lung or both lungs present. Blood test in the early stage of admission is usually helpful if the doctor is suspecting heart failure (BNP, PBNPT). If a patient is known to have a heart problem like weak heart, history of failure, heart attack, etc), in that context, getting sick with infection, especially pneumonia, may cause the heart to decompensate and heart failure may develop.

-Echocardiogram usually helpful to study the function of the heart. Also, if ongoing infection persists and doctors can’t tell where it is coming from the heart valve rarely can become infected, especially if the patient's immune system is not strong like we see in diabetes, advanced age, kidney failure, anemia, etc.

-Sometimes, if the pneumonia is viral pneumonia, not bacterial pneumonia, such as enfluenza and many viruses in our environment the viral infection can be longer in duration and it may cause weakness of the heart muscle called CARDIOMYOPATHY. Congestion heart failure may occur as a result. Treatment of the viral pneumonia sometimes may not alter the prognosis.

It depends on which valve and what's wrong with the valve and how long the condition has been present. Adult valve problems are entirely different from most of the child valve problems. In children, valve problems are frequently birth defects. Sometimes, infection on the valve leads to serious valve problems and life-threatening complications.

Here, I‘m going to answer adult valves only.
The most known sign of valve function or abnormalities is HEART MURMUR. During a physical examination, the doctor can hear an ABNORMAL MURMUR either from leakage or from narrowing in the heart valve. Sometimes, leakage and narrowing can be seen together. VALVE murmurs in young children and adolescents can sometimes be benign and may not cause any symptoms and may gradually disappear. Usually, in adults with valve problems, the valve develops slowly abnormal function, either leakage, narrowing, or both

Sometimes, a valve may have a minor defect at birth, but causes no problems in function until age 60 or older, when a valve starts to cause some symptoms and may need to be repaired or replaced. RARELY, A SUDDEN LEAKAGE IN A VALVE MAY OCCUR and may cause life-threatening shortness of breath and needs emergency surgery. It happens for the mitral valve in the presence of serious weakness in the mitral valve from a genetic disorder.

Symptoms are usually insidious or minor and develop very slowly over a few years. These symptoms usually slowly develop as shortness of breath during exercise of significant effort. An individual would notice that with time, doing the same physical effort becomes more taxing. When the function of the valve becomes worse, the symptoms become worse and shortness of breath would occur with much less effort. Chest discomfort may also develop as above depending on which valve. Serious narrowing in the aortic valve is more likely to cause chest pain than serious leakage in the mitral valve. DIZZINESS or fainting spells may occur. Palpitations and a tendency to have atrial fibrillation are not uncommon with serious leakage or narrowing in the mitral valve. Narrowing of the mitral valve is rarely seen nowadays and is typically caused by rheumatic fever, which is not much seen in the US and in the developed world. It still presents problems in the rest of the world.

There is some correlation between abdominal obesity and risk of developing coronation artery disease. Risk of developing Diabetes mellitus may also increase causing even higher chance for developing coronary artery disease.
cosultatiln with a physician is recommended for adviice.

6 weeks after the open heart surgery, I recommend a 3-month session of supervised structured form of exercise in a Cardiac rehab facility, phase II. Although it remains controversial, a stress test after completing the phase II rehab is advisable before resumption of the routine physical activity, such as running. It is advisable to do so in a gradual fashion. Consulting with the cardiac rehab physiologist prior to resuming running is prudent.

Heart attack means an abrupt cessation of blood and oxygen to part of the heart muscle, usually threatening sudden death or permanently damages and weakens the heart, causing various problems for the rest of one's life. The cause is typically related to a sudden clotting and closure of one of the coronay arteries feeding the heart muscle.

Often times, an individual may have one or many serious blockages and doesn’t get a heart attack because they don’t get the abrupt total blockage of any of the coronary arteries. Such an individual may have some suggestive symptoms such as a discomfort in the chest or shortness of breath when during physical activity. Sometimes, the symptoms are not very typical, especially in women, like on/off cold sweats, indigestion, fatigue, or a chocking sensation. Often times, people with hidden blockages may carry with them risk factors of coronary disease such as family history of coronary disease at age between 40 and 70, family history of immediate family members, like siblings, parents, first-line blood family members. Other risks include being over 45 years old, especially men, smoking, diabetes, hypertension, high cholesterol, obesity with poor dietary habits of high fat and high cholesterol, and lack of exercise.

If one has three or more risks, it would be prudent to follow up with a physician for evaluation to rule out a hidden coronary disease. A stress test is sometimes recommended and may help if the risks are present. Occasionally, there may not be any symptoms, even with the presence of high risks. A stress test may uncover a clue of the serious blockage, and further testing and appropriate treatment may prevent a heart attack and save a life.

To summarize this:
-If you are in the risk group and having suspicious symptoms, seek help immediately before sudden occlusion of coronary artery, which typically causes a heart attack to occur.
-If you have a high-risk profile, consult with your doctor to see if a stress test is warranted.
-To reduce your risk of having a heart attack, you need to lower you risk profile by addressing to an aggressive strategy to help lower the risk factors by avoiding smoking, or treatment of high cholesterol as your doctor recommends. Keep your blood pressure under good control by adhering to the medications, exercise, weight reduction, and restricting sodium/salt consumption and stay well hydrated.
-Strict dietary measures, exercise, and medications for controlling blood sugar in the case of diabetes mellitus.
-Check with your doctor if you should be on one baby aspirin daily.
-Stay on guard if you have significant risks factors and are having suspicions symptoms. Again, finding a blockage and treating it if necessary may avert a heart attack.
-If you are already a patient with coronary disease, your risk of getting a heart attack can be reduced by following the same strategy.

Thanks for your question.

1-I assume your husband received a stent. If so, then a strict compliance with his medications to prevent stent thrombosis, which is a potentially life-threatening complication, should be the most immediate task. If it was a dug-eluding stent, he has to adhere to a dual anti-platelets regimen religiously for a year or as recommended by his intervention cardiologist.
2-He needs to get guidance from his cardiologists as to when can he start a long-term exercise program, which should be preceded by a guided cardiac rehab program.
3-Secondary prevention, meaning a goal to reduce the risk of heart attacks, includes adherence to statins medications with goal of lowering LDL-cholesterol (the bad cholesterol) to less than 70mg/dL. Other medications such as Ace inhibitors, ARB’s, and Beta Blockers would depend on his condition and his cardiologist's advice.
4-Besides long-term exercise and goal of ideal BMI. Exercise should include both dynamic exercise (i.e., biking, swimming, treadmill, etc.) and stress or resistance exercise (i.e., free weights lifting or machines weights).
5-Smoking cessation, if applicable.
6-Stress reduction and management.
6-Adequate sleep.
7-If applicable, depression should be managed effectively.
8-Adherence to a healthy diet for the heart.

If Angioplasty was recommended that usually means that the vessel diameter is/are at least 75 % narrowed.
If the blockages are suspected to be borderline certain tests can be done prior to treatment with angioplasty. These tests may include ultrasound of the blocked artery ( IVUS), or other test (FFR),
If the blockages are significant by any of the above measures then intervention treatment with angioplasty and stent is necessary and knowing to reduce risk of heart attack, death, and other serious events. This is based on evidence from research.
Medications are necessary after stent or surgery,but would not get ride of the blockages .

I don’t exactly know the type and the etiology of cardiomyopathy which your father has.Because of his diabetes mellitus I suspect he has the most common type which is the ischemic dilated cardiomyopathy caused by coronary artery disease.
The condition suggests the following:
1-low ejection fraction ( impaired heart pump function)
2-congestive heart failure (shortness of breath, cough, ,edema, weakness,easy fatigue, anemia, pallor,......)
3- Enlarged heart size.
4-Arrhythmia (Electrical disturbances)
If the left ventricular ejection fraction has been less than 35% for at least 3 months there is an increase of sudden death, especilly if that caused by coronary artery disease ,prior heart attack ........etc.usually implanted defibrillator is recommend.

Fortunately the modern therapy and with regular monitoring for patients with this condition is very effective and it prolongs life.


You need to know what is the cause of his condition and the ejection fractions......etc if he wish to share it with you

Angioplasty (or stent) is less invasive and no incision is needed and is typically an overnight stay procedure. On the other hand, bypass means opening the chest wall and harvesting vessels from the chest wall and from one of the legs. The surgery requires bridging blood circulation from a spot above the blockage to a spot below the site of the blockage by using the harvested vessels. Also, there's a hospital stay for bypass surgery, usually from 4-7 days. This would depend on many factors, associated comorbidities or not (strong, healthy heart muscle vs. damaged, weak heart), other organs failure, such as kidney failure, or serious lung problems. Are there good sources of vessels to have the from?

Generally, bypasses are more durable than stents. Again, this is if the patient turns out to have a good caliber and good quality bypass conduits, which is typically used to bridge the blood from before the the blockage to after the blockage. Also, the rest of the blocked coronary artery we are doing surgery on has to be good for the bypass durability.

Many variable should be taken into consideration when deciding which is better for the patient. Sometimes you can choose either treatment without altering the patient outcome and lifestyle. In certain situations, the surgeon and the intervention cardiologist have to agree on one best form of treatment.

Nowadays, with the availability of much better stents, devices, and modern imaging modalities, the prevalence of stent in treatment of serious coronary artery disease has been rising steadily and has become more effective with acceptable risks of renarrowing.

I advise your father and your family to discuss his option of treatment and the pros and cons.

If your father was recommended to have bypass surgery and was deemed not a candidate for non-surgical options such as Stent/angioplasty or medical treatment and the surgeon is in agreement with the cardiologist, that means his risk of not having surgery is much higher than the risk of surgery, then he is more likely to benefit from the surgery.
In an expert's hands, in this country, major risks of bypass surgery in otherwise healthy patients are much less than 1 percent.

Yes, there is some evidence that all non-steroidal medications, Ibuprofen being one of them, may increase risk of heart attack. More commonly known risks include chronic kidney diseases, peptic ulcers, exacerbation of hypertension, fluid retention, and interaction with many prescription medications.

Scientifically and practically, modern medicine has proven to cure most diseases and save millions of lives. There is no evidence that natural, hollistical approaches to treating body and mind cure serious structural diseases such as heart diseases or any other structural and life-threatening disease.
I do, however, believe that these mostly philosophical and practical approaches to our life from healthy eating habits to sleeping to yoga, etc., are good behaviors and represent a secondary form of treatment in addition to modern medicine. Thus, I don’t believe that clogged arteries will respond to Ayurvedic.

Thanks for your question.
Smoking E-cigarettes may have less impact on developing hypertensive heart disease and its exacerbation. This is due to the absence of the paper component in E-cigarettes. However, there is no evidence that E-cigarettes are less harmful to human health in any form.

If you do not have major risk factors for premature coronary artery disease such as diabetes mellitus, systemic hypertension, hypercholesterolemia, smoking, family history of premature CAD or sudden cardiac death, “age 40-70,” etc., and no known family history of cardiomyopathy, means in the absence of any of these factors, I don’t believe you need to have a stress test until you are at least 50 years or older when you carry two major risk factors, “age and gender.”

Thanks for the question,
At 57 years of age, your mother should be evaluated not only for the palpitations, but also to rule out any associated cardiac problems. She would need an event cardiac monitor to determine what kind of cardiac rhythm abnormalities she may have. She would need an echocardiogram to evaluate her heart functions, which sometimes become abnormal in longstanding history of hypertensive heart disease. A stress test may be necessary depending on what the heart monitor and the echocardiogram reveal.
I suggest that she should see a cardiologist for consultation.

Anemia may very well contribute to shortness of breath.
Depends on the severity of the anemia. The heart responds to the body's demand for oxygen, which is carried by the hemoglobin in the blood, by substantially increasing work load. The heart workload may even increase three to four fold. Heart rate, “pulse rate,” is usually fast in the presence of anemia. Shortness of breath develops easily because the heart function's reserve is being utilized. Only so much hemoglobin is available for basic needs. Any physical effort needs extra blood to carry oxygen. With lack of extra blood, shortness of breath will occur.

Thanks for the question and I wish your dad an excellent, speedy recovery.
If your dad was a candidate, he probably did receive a stent as part of his emergency treatment for heart attack. The most important factor of prevention of a second heart attack in the first 6-12 months after the stent is compliance with the two essential medications to prevent the stent from clotting up. One of these two medications is aspirin and the other one would be selected by his doctor. Also, his interventional cardiologist will usually determine whether he sill has other significant blockages that need to be addressed or not. A timely stress test is usually recommended by his cardiologist, if necessary.

The other aspect of preventing a second heart attack is what we call a Secondary Prevention. Basically, it involves various other medications, which vary depending on your father's other medical conditions and risks. Typically, the medications may include statins for cholesterol, Ace Inhibitors or ARB, Beta Blockers, etc.
Lifestyle modifications which, again, depend on what his own lifestyle is (i.e., smoking, weight, diet, exercise program as recommended, mental stress management, etc.).

Regular follow-ups with his cardiologist and updating loved ones for unusual, new symptoms like chest pain are all important.

Thanks for your question.

Based on your observations, I highly recommend having your child evaluated. Initially, a pediatrician should run routine blood tests, urinalysis, and a chest X-ray PA & LAT and if all are OK, then I would consider a pulmonary functions test. Sometimes, bronchial asthma symptoms may develop from exertion, especially in cold weather.

A clue to a potentially cardiac issue of congenital nature should be entertained. An element of Cyanosis on exertion, “bluish discoloration of lips and finger,” may or may not be seen; certain abnormalities on a chest X-ray may provide a clue. An echocardiogram with a pediatric cardiologist may be necessary for a definitive diagnosis.

If that is all what you had, “a hole corrected with no other cardiac abnormalities in the heart," and its function has great prognosis during pregnancy. Specifically, not a large VSD and no associated pulmonary hypertension present, a well repaired VSD or ASD with no leakage in the aortic valve usually carries an excellent maternal prognosis to term with a vaginal delivery, or as deemed per obstetrician. At some point, the babe may need an echocardiogram. Not too soon, if he/she appeared healthy as a newborn.

Hypertension left uncontrolled is a major risk for stroke. Important elements to control hypertension include compliance with medical treatment, restricted sodium consumption, adequate water consumption, exercise, and weight loss. Diabetes mellitus, if present, increases risk of stroke 8-fold.
Heart rhythm abnormalities such as atrial fibrillation are known to increase the risk of stroke particularly in the presence of hypertension diabetes and associated heart disease.
Certain hidden heart defects such as a hole in the heart can increase risk of stroke.
The older the person becomes, the more associated other health issues similar to what mentioned above higher the risk of stroke. That's why certain effective treatments are usually applied to help prevent stroke.