Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.

Tenormain and Bleeding tendencies:
Tenormin has active ingredients of atenolol. It is used in high blood pressure, heart palpitations, mitral valve prolapse, atrial fibrillation/flutter, arrhythmias. Commonly reported side effects of Tenormin include weakness, high blood pressure, nausea, chest pain, fatigue.

Based on FDA data collected, 13,786 people reported to have side effects when taking Tenormin. Among them, 34 people (0.25%) have Bleeding Disorders. This problem is seen after a year on the medication in most cases. Though rare in occurrence, you just might be one among them. Please have your blood clotting parameters checked in a laboratory.





Leukemia:
To find out if you have leukemia, a doctor will:

Ask questions about your past health and symptoms.
Do a physical exam. The doctor will look for swollen lymph nodes and check to see if your spleen or liver is enlarged.
Order blood tests. Leukemia causes a high level of white blood cells and low levels of other types of blood cells.
If your blood tests are not normal, the doctor may want to do a bone marrow biopsy. This test lets the doctor look at cells from inside your bone. This can give key information about what type of leukemia it is so you can get the right treatment.






Echocardiography and Cardiac MR to evaluate valve diseases:
Echocardiography is now the standard tool for initial assessment and longitudinal evaluation of patients with valvular heart disease; however, echocardiography is limited in patients with poor acoustic windows and may be more operator dependent than other modalities, particularly for quantitation of disease severity. In the last 20 years, cardiovascular magnetic resonance (CMR) has emerged as an alternative noninvasive modality without ionizing radiation that is applicable to patients with valvular heart disease. CMR provides images of valve anatomy and allows quantitative evaluation of stenosis and regurgitation. CMR can also discern the consequences of the valvular lesion, including the effects of ventricular volume or pressure overload and alterations in systolic function. Therefore cardiac MRI has got an advantage over echocardiography while assessing disease severity in some patients.






Cardiac Coronary MR Angiography:
Cardiac Coronary MR Angiography may have to wait for additional advances in technology before its use becomes widespread.
The major impediment to coronary MRA is motion artifacts from breathing and heart motion. While these obstacles have already been discussed, they are more challenging in coronary imaging due to the small size of the vessels. Cardiac motion is at its maximum during mid-systole as the heart contracts and during early diastole as the ventricles fill with blood, thus images are acquired during mid-diastole when heart motion is minimal. Coronary blood flow is also relatively rapid during this time, having the benefit of enlarging the vessels being imaged.

For most cardiac MRI sequences, respiratory motion can be controlled by asking the patient to hold their breath. However, due to the high spatial resolution required, breath hold acquisitions are not possible for most 3-D coronary artery imaging techniques. Navigator imaging techniques can be used to eliminate respiratory motion from the image while still allowing the patient to breathe. With this technique, images are only obtained while the diaphragm is located a specified position across multiple breaths, thus limiting the effects of diaphragm movement

I hope this answers your query.
Do write in in case of doubts.

Regards,
Dr.Vivek

---

Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi,
Thanks for writing in with an update.

I am glad to know that you are aware of atenolol side effects and have consulted your dentist. If your dentist has examined your mouth and oral cavity and is unable to find any possible reason, possibility of injury to gums while using a hard tooth brush remains. There are certain conditions when the bleeding tendency increases and tests are available to confirm them. Though you have got a blood work done, I am not certain about the tests which were done. You may request a detailed examination by a general physician who could asses you further and recommend certain blood tests necessary to study your bleeding and clotting parameters.


It may not be serious in your case but there are about 26 conditions relating to bleeding from the mouth.

Trauma Causes
Oral trauma
Infected organ, Abscesses
Gingiva, abscess
Gingivitis
Abscess, periapical
Neoplastic Disorders
Leukemia, acute
Blast crises of chronic leukemia
Gingival carcinoma, lower
Myelomonocytic, acute leukemia
Carcinoma, oral
Carcinoma, tongue
Multiple myeloma
Oral carcinoma, floor
Gingival carcinoma, upper
Allergic, Collagen, Auto-Immune Disorders
Thrombocytopenia, autoimmune
Hereditary, Familial, Genetic Disorders
Factor IX deficiency (Christmas dis)
Von Willebrand's disease
Hemophilia
Anatomic, Foreign Body, Structural Disorders
Epistaxis/nose bleed
Varices, esophageal
Posterior nasopharyngeal epistaxis
Reference to Organ System
Hepatic failure
Thrombocytopenia
Renal Failure Chronic
Drugs
Mucositis/chemotherapy induced
Warfarin (Coumadin) Administration/Toxicity
Anticoagulants/Anticoagulation Administration/Toxicity


The above list might look exhaustive but I cannot single out any particular cause without having examined you clinically. Please do not get worried on seeing the serious illnesses listed above. If you have loss of weight, any swellings in your body, continuous fever (which doesn’t seem to be happening to you) then it must be communicated to your doctor.


I agree that there might be some confusion with regard to the use of terms MRI/ MRA in the general population. For basics MRI stands for Magnetic Resonance Imaging in which the body is imaged using a huge magnet and radio frequency waves. So if we see the bigger picture, MRA of heart is a type of special MRI of heart to study the blood vessels like coronary arteries.

MR Angiography is a specialized form of MRI in which we see the blood vessels more clearly. Therefore the machine is the same but only the picture is more suited to see the blood vessels in MRA. In simplified terms, Angio is blood vessel and graphy is to interpret through imaging. MRA can be done in brain, aorta, limbs, basically any region where there is flow of bold. In heart, MRA usually applies to the study of coronary arteries.

The problem with MRA of coronary arteries is that there is significant motion of the small vessels due to breathing and the quality of images are still being assessed to make them error free and more accurate for clinical interpretation. In this area, CT coronary angiography is giving better results which are comparable with that got using cardiac catheterization. The only advantage of cardiac catheterisation is that should there be any blockages, they can be opened using balloons and stents at the same sitting and patient is treated immediately. But little risks always persist in cardiac catheterization and patients can take an informed decision on which procedure to go for.

Similarly if we try to image the heart chambers and valves, we call it as Cardiac MR or CMR. These are just abbreviations for convenience of communication among doctors and technologists. MRI of heart for evaluation of valves shows more of the heart chambers and pumping capacity and valvular flow details. This is better than echo in patients whose chambers are less clearly seen in echocardiography. Cardiac MR is operator independent which makes it more acceptable. Therefore Cardiac MR may give better information than echocardiography in some patients.

I hope this answers your query.
Do write in in case of doubts.

Regards,
Dr.Vivek

---

Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

In my opinion, with a body structure of 5'5" and 124 lbs, I feel echocardiography image quality will remain optimum, this may be confirmed by asking the person doing the echo. Should there be any unclear areas in your echo report, then you can request a Cardiac MR to study heart chambers and valve functions.

The blockages in coronary arteries need to be evaluated through cardiac catheterization or CT Angiography. Radiation is involved in both but the procedure risk is much lower in CT Angiography. Again, for any treatment, should there be any blockages, catherterization or surgery might be necessary. So I suggest you take an informed decision on this matter, whether to go for catheterization or CT Angiography.

For you oral bleeding, you can get a peripheral blood smear test and confirm absence of any abnormal appearance of wbc. Leukemia shows immature wbc in the peripheral blood smear Some of the other causes need to be ruled out clinically.

I hope this answers your query.
Do write in in case of doubts.

Regards,
Dr.Vivek

---

Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

In cardiac catheterization, the passage of catheter from groin through coronary arteries is done under X XXXXXXX guidance using a highly sophisticated machine. In catheterization the radiation dose received is about 4.6 - 15.8 mSv and in CT Angiography it can be about 8.0 mSv. So there we see, no significant difference in radiation doses in the two investigations.

For oral bleeding you can get your clotting profile done. Along with that a complete clinical examination of nose and throat might be necessary. Liver function and kidney function tests may be done. Peripheral blood smear needs to be done with complete blood count (if not done earlier).

I hope this answers your query.
Do write in in case of doubts.

Regards,
Dr.Vivek

---