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Dr. Andrew Rynne

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Suggest treatment for severe dizziness in an elderly person

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5894 Questions

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Posted on Tue, 7 Mar 2017 in Hypertension and Heart Disease
Question: i am a 51 year old female who has had what i called spells for almost 5 years when my heart felt like it suddenly started beating wildly and i would feel really faint and need to lay still for a few minutes until i was no longer dizzyy i went to myheart specialist and they caught it on an ekg. i agreed to take a stress test and when i went to the third level on the treadmill the guy doing the test suddenly freaked and immediately stopped the test. i suddenly felt very very dizzy and the test showed i had sudden death rhythm. they immediately sent me to emergency room and after a heart cat the doc told me i had a misfire in my heart in one spot. i didn't get a chance to talk to him very long so i wondered if i could die from this if i had an episode that was bad. in the past 5 years i have had many some less severe than others doc said it would not kill me. how do i know for sure
doctor
Answered by Dr. Ilir Sharka 58 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that your symptoms seem to be related to a cardiac arrhythmia.

I would like to review your performed test reports in order to give a more professional opinion on your clinical situation.

But, as 5 years have passed and your situation has not changed, it doesn't seem to be a lifethreatening condition.

Anyway, I would recommend performing some new tests:

- a cardiac ultrasound
- an ambulatory 24-48 hours ECG monitoring
- complete blood count for anemia
- blood electrolytes for possible imbalance
- thyroid hormone levels for possible thyroid dysfunction.

You should discuss with an electrophysiologist on the possibility of cardiac ablation, based on the above test results.

Hope to have been helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 1 hour later
i have done all the tests you have mentioned. my regular heart specialist has ran everything. I have a 4mm hole in my upper chambers and i also have a leaking valve. No thyroid problems. 5 years i have been telling her what my heart was doing and never caught by her in the office. finally during my second treadmill test in those 5 years my heart did what i had been experiencing all along which freaked out everyone in the office. They only expected me to have a blockage somewhere not to have a sudden death rhythm. when i went to the hospital the top surgeon explained i was rare and most people die from this. he said the plumbing of my heart was excellent but the electrical part had one spot that was bad and that he could burn it and hopefully it would stop doing that or i could take a beta blocker which i already do or high blood pressure to control it but it has not controlled it in the past. He said it was not life threatening but everything i read said it is so i don't know what to do other than get other opinions. on the stress test my heart wnet from 124 beats on the second level to 194 within seconds and the graph lines were huge up and down marks. i layed down and within a few minutes my beats were normal again. this happens regularly when i am exerting myself like working hard at work or in the yard. I have had to lie down for a few minutes to recover or several minutes I don't know if the next time i do it will be so bad i can't recover though
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again, dear Victoria!

I would like to thank you for the additional information you provided.

As you are suffering form an atrial septal defect, I could explain you that those skipped beats and overall palpitations are common findings in such clinical milieu.

Atrial septal defects frequently lead to abnormally increased volume and pressure overload within cardiac chambers with subsequent left atrium, right atrium and ventricle dilation.

Also, an additional potential complication is increased pulmonary hypertension, which when becomes persistent and importantly increased, may revert the abnormally present left to right blood shunt through the septal defect.

So, as you see ASD may lead to cardiac arrhythmias, most frequently atrial arrhythmias (atrial fibrillation and flutter; it is likely to explain your palpitations and episodic dizziness).

Coming to this point, it is necessary a careful review of your cardiac structure and function for defining potential changes imposed by ASD, and if appropriate conditions are met (no irreversible pulmonary hypertension, no Eisenmenger syndrome and the anatomic surrounding of the defect is suitable for a favorable apposition of a closing device), it would be rationale to program a percutaneous closure procedure of your ASD.

Of course, the surgical strategy would be an option, but it seems more traumatic.

It is for the above mentioned reasons, that a new trans-thoracic cardiac ultrasound and a trans-esophageal cardiac echo are highly recommended.

So, coming to your concrete question, I would explain that an individual may coexist with an ASD almost uneventful up to his 80 or 90 and it seems that your atrial septal defect is not a large one.

Atrial arrhythmias when present may be properly treated.

It is necessary to establish a chronic anticoagulation therapy if atrial fibrillation appears in order to prevent a cardio-embolic event.

But, if favorable conditions are present for definitely closing the defect, I would decisively go in favor of that strategy.

That's my opinion.

You need to discuss with your attending cardiologist on the above mentioned issues.

Hoping you are having a pleasant weekend!

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 6 hours later
your opinion is very good and different from the heart surgeon i spoke with briefly. He seemed to think i had a electrical problem with one spot in my heart and not with the asd. I recently had a new echo within the last two weeks and the findings were that the leaking valve i also had was leaking more but that's all the regular heart specialist said and that's when she suggested a nuclear stress test of which i had last week and during the third level of that test in walking i suddenly went into sudden death rhythm. I have only know about the small hole in my heart for about 5 years also but knew i had a murmur since i was 17. I also found i had high blood pressure about 5 years ago also and know it has also damaged a part of my heart where he said something that should be straight is wiggley but did not understand what.It is my understanding that you think it is the asd causing the problem or have i gotten that wrong? I have fought the regular heart specialist she seemed to think it was not my heart making my problems but maybe my thyroid of which i did all the tests for that and turned up nothing. I am so confused about everything. I can't find a whole lot of reading on asd in adults because most are caught when the patient is little but have read everything i could. I have read on sudden death rhythm and am very confused about what is causing my problems. Thank you so much for your opinions. I will not give up on this and hopefully i will find what it is. The heart surgeon seemed to think he could fix the asd, valve and the electrical problem but i have another week before i visit his office for the first time to really hear his opinion.Also i did find out 5 years ago i had a left to right shunt. I am used to the fluttering and skipped beats but thats not what i have when i have these episodes. These are different from them. I am usually or had been working hard when they happen. A couple of time i had sweat from head to toe i am incredibly dizzy so bad that if i don't lay down where ever i am i would have ended up falling down. Some times its 5 or ten minutes and i am up and normal and sometimes much longer. I just didn't think an electrical problem could suddenly start out of the blue. i have never had these episodes like i said i always had a murmur but when i turned about 47 or 48 the murmurs and fluttering got worse and about a year after that the episodes started
doctor
Answered by Dr. Ilir Sharka 16 hours later
Brief Answer:
I would explain:

Detailed Answer:
Dear XXXXXXX

Those episodes need to be closely monitored in order to give an exact explanation why they happen.

Except for the episode occurred during nuclear stress test where the reason was confirmed to be a complex arrhythmia; other repeated episodes of profound sweating, dizziness and near fainting could be an abrupt deterioration of the hemodynamic status (presented with resulting arterial hypotension) due to a paroxysmal exacerbation of cardiac arrhythmia or bouts of increased pulmonary vascular resistance (due to physical exertion).

Nevertheless, cardiac arrhythmia remains the main suspicious reason.

Regarding the therapeutic strategy of facing with ASD and subsequent cardiac arrhythmias (most commonly atrial arrhythmias as I mentioned before), a surgical strategy could offer ASD closure as well as cryo- or radio-frequency ablation (modified Maze procedure) at the time of procedure.

In addition, the results are quite optimal (regarding eradication of recurrent arrhythmias) when performed in the first 25 years; after that, especially after 40 years, the results are relative and recurrences of arrhythmia in general are not affected by ASD closure.

Also, late post operative arrhythmias may occur and they could be treated successfully with ablation again, in case a re-entrant tachycardia or atrial flutter is the reason.

Atrial fibrillation instead, is usually controlled with anti-arrhythmic therapy and chronic anti-coagulation.

So, to conclude, both ASD closing options are possible (surgical and percutaneous).

It is important to properly fix the suitability of ASD closure indication.

I remain at your disposal for reviewing any available cardiac tests (TT & TE cardiac echo, Holter monitoring, ECG, etc.) and giving a second professional opinion.

You should discuss with your doctor on the above mentioned issues.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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