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E-mail received:
Please give me a simple definition of PPS murmur (peripheral pulmonic
stenosis) and what it entails. My 3 week old daughter has it. Should I
worry? Thank you
Dr Matthews response:
The murmur comes from a narrowing of a segment
of the pulmonary artery above the pulmonary valve or the narrowing can
be in one of the pulmonary artery branches(right or left).The murmur is
a harsh noise peaking in the middle of the cycle of the heart contracting
to push blood through the pulmonary artery. The blood going through a
narrowed segment of the pulmonary artery creates this noise,best heard
just to the left of middle line of the chest, up close to and under the
left collar bone(clavicle) and can also be heardunder the left arm and
in the back! The clinical course is favorable in most patients with mild
to moderate obstruction of the pulmonary artery.In a national study,865
of patients had no significant increase in their pressure gradient over
a 4 to 8 year interval.Those with a significant increase were less than
4 years old and had at least moderate narrowing initially.Even mild obsruction
may progress significantly in some infants in the first year of life.
The prognosis of those with severe obstruction without surgery is poor,
especially in infants with critical obstruction.Among the 580 patients
alive at the completion of the above referred to study, new data were
available on 464.The probability of 25 year survival was 95.7% compared
with an expected age- and sex- matched control group survival of 96.6%.97
% were asymptomatic. There was no stenosis(narrowing) in 2%,mild in 93%,
,moderate stenosis in 3% and severe stenosis in only 1%. RJM
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E-mail received:
I was recently hospitalized with symptoms of shortness of breath, sweating
and a clammy feeling and heaviness in the chest area. I has several ekg's
and chest xrays, which all were normal. I also had a cardiac catherization,
which showed no blockage. A pulmonary doctor saw me and several pulmonary
function test were performed. They too turned out normal. I am out of
the hospital now but still have the same symptoms. My mother died at the
age of 58 from cardiac arrythmia. I was put on a low fat, low cholesterol,
low sodium diet. I am overweight so the doctor is saying that it is probably
due to the weight, but I have always been heavy and have never had this
problem before. I am still very concerned that something is being missed.
What can you possibly attribute these symptoms to? I have follow-up appts.
with the cardiologist and pulmonary doctor and I really feel that there
is something else going on. What suggestions of information do you have
that can be helpful?
Dr Matthews response:
What about age, family history, your lipids,
thyroid tests, blood sugar,stress in your life (both emotional and physical,business,
family conflicts, ladies, drugs, your abilityy to cope), exercise echocardiogram,24
hour Holter test, current exercise program and your discipline to it!
RJM
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E-mail received:
Dear Dr Matthew I have had a caesarian section a hysterectomy and a
laparoscopy operation in my tummy. I started to have excruciating tummy
pains with pains going up through my chest and neck veins. I get breathless
on exertion and extreme fatigue cold abdomen and cold heavy legs and terrible
throbbing pains in my head. The left side of my head has pins and needles
and numbness and severe pain, I have unexplained dizzy spells I was told
these symptoms was fibromyalgia. I had a stress mill test and it was stopped
as I was so fatigued and breathless I was found to have a systolic heart
murmur on the left sternal edge. The echo scan was done and the heart
muscle was okay. The cardiologist saAC1021
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iźŅĢ¾3Z ŻB«u!lL·„*×:ĖĻå#*qŖ{0sĪ½×§±”ätCćĄ-ÄJĘ:ßā ŁfbŖr^õK¤ó¹’:ķčXc¢Ų¾1čbcÖ§)°kkT§>ŌÉŹ±87įsÅé~|zTŅ^·żl”xéįóŌ4@M*apĪ
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šĮäTśÖ”®b>P0b :>Õ8rĻń®8µÓf"pZ l> P} Åe£ēcŽŌ “=ŻŖDJ§ lPZ*m½ óŅåż}ūsQRńāKłI%I$ü¤x4ü+&ŖG{EŌ“=^ń,æų³^Ś)#Wo)Š £į6éZźbbÆžĀA’Ō ®xļbk«¤t)XTŪĻ§{ØNowOģ« ł Į6»·Z=Og[æ 5÷ń]īiency that characterizes
protein-calorie undernutrition in more mature individuals has been studied
by a number of investigators.23 In human adult volunteers on a semistarvation
regimen, significant reductions of heart rate, stroke volume, cardiac
output, and heart size were observed during the development of cachexia.
Cardiac output, however, did not appear to fall out of proportion to the
diminished metabolic requirements. In addition, an echocardiographic study
of patients with undernutrition secondary to a variety of chronic disease
states found that the reduced cardiac output was associated with a diminished
left ventricular end-diastolic diameter and mass. When adjusted for body
weight, however, the cardiac index was higher than that of normal control
subjects. Anorexia nervosa influences the cardiovascular system in several
respects. Observations of a group of individuals with anorexia nervosa
showed that the systolic ejection phase indexes of left ventricular function
were normal and responded normally to exercise. The patients in this study
were considered to have an adult marasmustype syndrome that did not significantly
affect cardiac function; however, on two-dimensional echocardiography
the left ventricular mass was found to be reduced to between one-half
and two-thirds that of age- and sex-matched control subjects. This reduction
was even greater when left ventricular mass was considered in relation
to total body weight. Left ventricular afterload was reduced, while resting
left ventricular function was normal. With the change in skeletal muscle
mass the response to exercise was limited, with a lower peak oxygen consumption.
In addition, there were reduced increments in heart rate and systolic
blood pressure. Analysis of substrates in systemic blood showed normal
glucose responses to exercise; however, free fatty acid concentrations,
which doubled in control patients during exercise, showed no change in
the anorexic group. The ECG in anorexia nervosa is generally unremarkable,
but some patients exhibit nonspecific ST- and T-wave changes. Patientsrecovering
from anorexia show improvement in heart eate andin left ventricular dimemsions.
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