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Had subclavian carodid bypass done for suclavian steal syndrome. Where the heartbeat is coming from?

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Practicing since : 1981
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I had a subclavian carodid bypass 2 years ago for suclavian steal syndrome my main compaint was i could hear my heartbeat in my head i guess form the reverse flow ,it was dipilitating so they did a caqtherization and found the sss did the surgery and the heartbeat went awayfor two years, recently the heartbeat is back , adopler was done and the artery is still open and flowing fine , now they dont know where the heartbeat is coming from, do you have any idea what could make it return
Posted Thu, 16 Aug 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 41 minutes later
Hi there,
Thanks for writing in.
I am qualified and certified cardiologist and have dealt with some cases like yours.
What happens is carotids give rise to respective right and left middle and anterior cerebral arteries, two vertebral arteries arising from second part of respective subclavian arteries join to form basilar artery which give rise to posterior cerebral arteries. The circle of anterior arteries origin, middle cerebral arteries origin and basilar artery form Circle of Willis. In the block of first part of subclavian artery the huge blood flow which the arm needs comes from verterbral artery from this circle that is subclavian steal syndrome. Angiography delineates it all well. As with every heart beat with some delay vertebral takes blood away from brain you had perceived as tug or heart beat as you call it. Subclavian carotid bypass did take away this role of vertebral. Now, only reason the tug of heart beat is back is vertebral artery of opposite side is doing the job which the side of bypass was doing. It was not picked up (if Doppler examination was done two years whether it had picked up the steal?) by Doppler examination; for Doppler examination has poor sensitivity for XXXXXXX seated and posterior segment of circulation containing vertebral and basilar artery (which in any case being two time the size of basilar is not prone to give good Doppler signal). However, CT Angio of carotido-vertebral system will pick it up in non invasive way without you to have to undergoing catheterization procedure again. Well this is my interpretation of the situation. If someone has better explanation I stand corrected. I shall try to answer any question you with pleasure. Good Luck.
With Best Wishes

Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
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