Your Questions Answered
"I had a heart attack in January 2019 and for the last several weeks have developed a lot of anxiety to the point some days I don't feel that I should leave my house. Is this normal and what can I do to get rid of these feelings?"mustang29, Support Network Member
"Nearly everyone goes through a period of heightened fear following a heart attack. About 15-20% of survivors will develop anxiety that is severe enough to meet the criteria for an anxiety disorder. If you are finding yourself so gripped with fear that you can’t leave the house—or are so preoccupied with worrying about another heart attack that you can’t concentrate on anything else--then I recommend you meet with your primary care provider to be assessed for an anxiety disorder. We have excellent treatments, including psychotherapy and medications, to reduce anxiety symptoms and restore some sense of safety. That may be a crucial step for you to get back to enjoying living once again.—Barry J. Jacobs, Psy.D., AHA volunteer and co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"I am 59, I have controlled diabetes (A1C in normal , non-diabetic range) and my BP runs slightly high. Recently I had what I thought was a bout with pneumonia. I had all of the symptoms except a bad cough. I had a slight cough. A few days after it cleared up, I was able to see my doctor, who ordered a chest X-Ray. He did find water in my lungs but no signs of pneumonia. He sent me to a cardiologist who examined the X-Ray and he heard a murmur when he listened to my heart. My EKG was perfect, but he thinks I have a leaky aortic valve. I'm waiting for an opening to take a stress echo, but in the meantime I'm pretty stressed. I run on an elliptical for a vigorous hour every weekday. I have never had even a hint of pain or shortness of breath (except for what I thought was pneumonia). In fact, I had just finished a good run just before my visit with the cardiologist. Does it seem feasible that my pneumonia had cleared up enough that it wasn't visible on the X-Ray? I hadn't had any symptoms for days and had actually resumed a pretty vigorous routine on the elliptical machine before the X-Ray. Could it be that the Cardiologist just missed it? It may be worth noting that at the time of my "pneumonia" I was also under extreme psychological stress and hadn't slept a wink for several days. I was feeling pretty bad both physically and emotionally. Any input would be greatly appreciated."Troyanna, Support Network Member
"It’s hard to say what the cause of your pneumonia-like symptoms were. Pneumonia can be caused by a virus and resolve on its own. But pneumonia has a pretty distinct look on x-ray. It’s also possible the combination of common cold and the physical and emotional stress you were experiencing, mimicked pneumonia.Tessa Messinger, Critical Care and Clinical Research
The combination of having an x-ray showing fluid in your lungs and a heart murmur does start to paint the picture of a heart valve disorder. I would continue to follow up with the cardiologist and complete the echocardiogram as this will give the best picture of where the fluid came from and what is causing the murmur. As heart valve disease is a progressive disease, it is possible to live free of symptoms for a long period of time, as your body gradually compensates for the changes. This would explain why you are still able to have such an active lifestyle. . It is not necessary to treat valve disease until the measurements are moderate to severe, and symptoms (shortness of breath, dizziness) are significantly affecting quality of life. With any luck this will be many, many years down the road for you.
Thank you, Nurse Tessa"
"Hello! In August of 2018, I was diagnosed with a Bicuspid Aortic Valve with very trivial leakage. I have been an anxious mess since then, and have had the worst thoughts. I had an echocardiogram at St. Francis hospital in Roslyn NY, and have a few questions. Firstly, how at risk am I for cardiac events like fainting, cardiac arrest etc? Second, the doctors told me of no other issues, so does that mean there is still possibility of other cardiac problems? They took 1 ekc and 2 echos, and that is all that they told me. If anyone could please get back to me id be happy to know, thank you so much!"tommylow900, Support Network Member
"Simply having a bicuspid valve does not put you at any greater risk for sudden cardiac events. Bicuspid aortic valve disease is something that many patients never know they have until it is found during an echo for other reasons, many times much later in life.
The main risk with a bicuspid valve is progressive stenosis or gradual narrowing of the valve. The best way to monitor this is with regularly scheduled echocardiograms and visits with your cardiologist. This will allow your cardiologist to see the rate of change in your valve and discuss the severity and frequency of your symptoms. It is not necessary to treat a bicuspid aortic valve until the leakage is moderate to severe, and symptoms (shortness of breath, dizziness) are significantly affecting quality of life. With any luck this will be many, many years down the road for you. Thank you, Nurse Tessa"
"If all statins fail (bad side effects) are there injectable statins and won't they possibly cause the same side effects. I have been on 2 different statins and they result in achiness and sore muscles."brookster, Support Network Member
"The FDA has recently approved Praluent and Repatha both PCSK9 inhibitors. However they are both for very specific populations of patients. I would suggest visiting both medication websites to see if your medical history and conditions would allow you to be prescribed either. Then speak with your doctor to see if they think they are right for you. You may need to have documented trials and fails of statins in order for your insurance to cover the new drug.Tessa Messinger, Critical Care and Clinical Research
You should also ask your doctor what the current cholesterol guidelines are, and if your blood work are close to these goals. There are also supplements such as fish oil and Niacin that may be beneficial, but don’t start anything new until speaking with your doctor or pharmacist about how they may interact with other medications you’re taking.
Thank you, Nurse Tessa"
"i have CHF and have a very hard time sleeping, mostly in a chair so i can breath ... and tip or ideas how to make sleeping easier"joetwentytoo, Support Network Member
"For some heart failure patients sleeping in a chair is their new way of life, for others it is a sign that they are in a fluid overloaded state. I would first talk with your heart failure specialist to ensure that you are on the correct medication regimen and not fluid overloaded. Other signs of fluid overload can include shortness of breath, especially at rest, ankle or foot swelling, and weight gain.Tessa Messinger, Critical Care and Clinical Research
As far as making sleeping easier, have you tried multiple pillows in bed to mimic the same position as the chair, but allow you to roll side to side? Or possibly an adjustable bedframe that would allow you to elevate your head and remain in bed? If you’re backside is getting sore from the pressure I would try an egg crate mattress or foam pad to relieve some of the pressure.
I hope that you’re able to find a more comfortable way to rest.
Be well, Tessa"
"Greetings, How best to prevent another stroke. How best to re-cover eyesight, use of arm. Thanks, Sophie"smoine001, Support Network Member
"You can present another stroke by seeing your local stroke specialist or primary physician and inquiring into why you had your stroke. First, address the reasons for your first stroke and then attend to additional reasons for having another stroke. This secondary stroke prevention is best accomplished through stroke risk identification and modification. Afterward, begin medications known to minimize stroke such as an antithrombotic medication and cholesterol-lowering statin. Thank you, Dr. Joseph Hanna"Dr. Joseph Hanna, Neurology
"I'm hoping that someone could give me some good advice, mainly financially, following a stroke last summer. I still have a lot of recovery left to do, but I've made a lot of progress as well. My big problem is that I couldn't access money in the hospital and afterward, partly because I had no memory of computer passwords at all, which caused bank problems after 3 months. Which in turn is likely to have me losing a whole year of income from the state, which will likely make me homeless. The crazy thing is that I have that money from the state--I just can't get at it to it give it to them. I hope this this makes some sense."sadness, Support Network Member
"I am sorry that you are having such a difficult time. I suggest making an appointment with state officials and back personnel in your community so that they might assist you in accessing your accounts and keeping a roof over your head. Thank you, Dr. Joseph Hanna"Dr. Joseph Hanna, Neurology
"My husband had a stroke four years ago. Lately he has become verbally abusive, refuses to see his counselor, and refuses any type of PT. He is had a right side stroke and very severe one. He is totally paralyzed on his left side, has left side neglect and recently I have noticed some cognitive difficulties. This has taken a severe on my physical health. He is 62 and I am 56. Eight years ago I had a neck fusion. And just found out that some of the screws and hinges have failed and I require further surgery. After hearing this he has become more abusive verbally. And for some reason has become extremely dependent on me helping him move around. Things that he’s done in the past, he chooses not to do anymore. How can you help me? How can you help me get him back on the right path."WinterSimms, Support Network Member
"You are describing a relatively sudden change in your husband’s behavior and his cognitive abilities. There are two possible (though not mutually exclusive) reasons: He has had additional small strokes that have gone undetected but have caused further damage and changes. Or he has developed Major Depressive Disorder. In either event, he needs a medical evaluation to figure out the cause. There may be some underlying condition which is remediable. Your husband may yet be restored to a more agreeable and less verbally abusive man. –Barry J. Jacobs, Psy.D., AHA volunteer and co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"My dad called me on Feburary 2, 2019 it started off a normal call so I thought. Just then he wasn't acting normal. I listened closely and found out my dad had a stroke. He kept telling me something happened last night. I rushed over to his house see he was in a stroke. Rushed him to the hospital. Was doing okay. Talking, walking. Then bam nothing. Sadly I lost my dad a week later. Massive stroke and I wish I could have saved him. If only i would of called him that night."SelinaBarnes, Support Network Member
"I’m so sorry for your loss. It sounds like you cared about your dad a lot. I understand your wish to have saved him. We all second-guess ourselves and ask “What if…” after the death of a loved one. What if—by luck or fate—you had called your dad the night before? There’s no telling that that would have prevented his death from a major stroke. I hope that you can avoid feeling guilty. This was not in your hands to control. As the Serenity Prayer so neatly states it, “God grant me the serenity to accept the things I cannot change.”—Barry J. Jacobs, Psy.D., AHA volunteer and co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"About 3 months ago my 16 year old daughter found me on the floor in the living room in the middle of the night. She said I was slurring my words not making sense. She said when I tried to stand up I couldn't. Some how she managed to get me to the ER. All they did was xray my ankle, which was broken, and send me home telling her everything else would just clear up. I continued to have the initial symptoms and also right sided weakness, balance problems and falling, and my daughter said my affect was flat. I have no memory of the first two days. Symptoms lasted about 5 days. MRI and EEG were negative. I had an episode a few weeks earlier of confusion that lasted about 15 minutes. I have no risk factors for stroke. I am curious as to what this may be."brindallrn, Support Network Member
"A local physician with access to your records is best suited to answer your inquiry. However, four things cause abrupt neurologic change – stroke, seizures, metabolic derangements, and migraine. The first and likely last two are excluded by your evaluation if as reported is accurate. Only, seizure remains to be explored. Please consult a local physician to aid in your health. Thank you, Dr. Joseph Hanna"Dr. Joseph Hanna, Neurology
"I think that I have already asked these questions just on a different condition. I was born with a bicuspid valve that was not found until I was 34 by then the words that were told to me was not severe aortic stenosis it was you have a case of gnarly aortic stenosis I chose the mechanical valve I had an on-x valve. but I still never really got my energy back and my heart palpitations still never really slowed down. Unfortunately I did not understand the importance of the Coumadin everything happened so fast that all I know is I needed to choose mechanical or bio I chose mechanical because I did not want to have another surgery. 4 years later because I did not take my Coumadin the way I was supposed to my valve thrombosed and probably had been for a while I had blood clots in my lungs and had many heart attacks and I don't have normal chest pains so the entire time I was having these I thought I had a cold. Once I was in the hospital and they realize that the dog was thrombosed my stenosis had became worse so I was not approved for the Cath valve replacement to fix the thrombosed valve because I also had to have my aortic replaced with the graft. my heart is one of the smallest hearts that my doctor had ever had to work on before when he got in into the valve he said it was like a confetti of clots they did not believe that I would wake up and if I did that I would be myself at all so I just want to put out there to anyone who has a mechanical valve please take care of your INR and your Coumadin it is so very important. of course I had other factors that contributed to that but my question is I have hit a year now since my aortic valve re replacement and aortic graft replacement and my energy level is still very well I am tired all the time and my heart palpitates a lot which I know is normal with the mechanical valve but it is like almost every 5th beat and sometimes it will palpitate over and over and over before it goes back into a normal rhythm. I have been in congestive heart failure twice luckily the medications have worked wonderful and I get back to normal less fluid build up but I still don't get the energy buildup I have also warned an event monitor and was told that it showed nothing of concern and that's when I was told that it's normal to have palpitations with a mechanical valve keep in mind I had already had a mechanical valve four years prior and my heart still didn't palpitate this much and I know on the event monitor I don't think that I was hitting the button until the event was pretty much done. With this last surgery it was an emergent I really didn't even get a choice as to anyting or time to think about what was even going into my body I don't even know what a life expectancy is for someone with a aortic graft replacement along with a hritik valve re replacement.Basically I guess what I'm getting at with my questions is how long does it take to get your energy back after a surgery like that and although I know palpitations are normal with a mechanical valve how many palpitations is not normal and how can I find out what my life expectancy possibly is because when I asked I get told multiple answers by every different doctor I see every question I ask I get multiple different answers from every doctor I see from my cardiothoracic surgeon to my cardiologist to even my internist. I just last week got to fill with the graft is inside my body and I am scared and terrified I'm a single mother of three who has had to open heart surgeries and should not even be here right now but by the grace of God and the doctors an anesthesiologist and pulmonologist and nurses and everyone who was there to help keep me stable their wonderful hands are why I am here. But I truly live in fear every day of the stroke of a blood clot not knowing if the palpitations are normal not knowing how long this can even last inside me because to me I feel like it's almost a car part and car parts brake and I've already had one break inside of me. So I'm just asking these questions for a little bit of Peace of mind"Imajeus, Support Network Member
"First of all, I’m so sorry that you’ve been through so much! WOW! What a rollercoaster!Tessa Messinger, Critical Care and Clinical Research
Whenever I hear of a patient experiencing palpitations that other physicians have brushed off, I strongly recommend seeing an electrophysiologist (EP). They are cardiologists who specialize in the electrical system of the heart. Your palpitations may be your new normal, but I believe an EP doc is really the one who will get to the bottom of what they are, if they are worrisome, and how to treat them. I believe they are the best equipped to explain what it means when a monitor shows “nothing worrisome”, and what that really means. I encourage you to ask for education about your condition, not just reassurance that “Everything is fine” Knowledge is power when it comes to your own health.
Thank you, Nurse Tessa"
"Just diagnosed with mild left ventricular hypertrophy. My cardiologist wants me to lose weight and lower my blood pressure. Can this diagnosis be managed?"MaaMaa, Support Network Member
"Yes, absolutely. The combination of high blood pressure and elevated weight, increases the stress and work load on your heart, especially the left ventricle. Think of applying pressure on a garden hose, upstream from the hose the pressure rises, and as the pressure rises the hose may strain or stretch. High blood pressure is that pressure downstream from your heart.Tessa Messinger, Critical Care and Clinical Research
So by lowering your blood pressure and weight, the stress on your heart will decrease. You may not be able to un-do what is already done, but positive changes will slow the progression of the disease.
Thank you, Nurse Tessa"
"I can not get over my condition,feel trapped. 6 stents over 11 years. 2 in 2007,4 in Feb 2019. Doom and gloom, help please."jimphillips, Support Network Member
"Doom and gloom” sound like signs of helplessness and hopelessness. The adversity and setbacks you’ve faced over a long period of time might warrant that response but also are likely symptoms of clinical depression. Have you met with your primary care provider to be evaluated and possibly treated for depression? Feeling less depressed won’t cure your heart problems but it will improve the quality of your life and decrease your suffering.—Barry J. Jacobs, Psy.D., AHA volunteer and co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"What cause heart palpitations? I had double bypass 15 years ago--feels like a blockage--I don't want to go through open heart again. It would financially ruin me...nitro helps. Doesn't seem to bother me when I'm working hard...I'm almost 70..."jimyed, Support Network Member
"Heart palpations are a feeling of fluttering in your chest, or feeling like your heart is skipping a beat. They are a caused by an electrical disturbance in your heart, and do not necessarily indicate any blockages in your coronary arteries (heart vessels). Heart palpitations are not relieved by nitro.Tessa Messinger, Critical Care and Clinical Research
Angina (chest pain) can feel like pressure, squeezing, aching, or pain, and generally indicates a blockage in a coronary artery. Angina is caused by decreased blood flow through a coronary artery, the pain is the affected muscle saying “help! I’m not getting enough blood flow!”
Sublingual (under tongue) Nitroglycerin (Nitro) works by temporarily dilating or enlarging your coronary arteries. The blood can then flow regularly, the muscle gets the blood flow it needs, and the pain goes away.
You have known coronary heart disease, unfortunately bypass surgery does not remove your disease. There are many more treatment options for heart disease and angina than there were 15 years ago. I would highly recommend speaking with your cardiologist about your symptoms, their frequency and severity. Sometimes angina is a blockage in a larger vessel and may require an angioplasty (ballooning), or stent placement. This procedure typically only requires one night stay in the hospital and minimal recovery. Angina can also be just small vessel disease that doesn’t require a procedure, but simply an adjustment to your daily medications. There are medications that do what nitro does but last all day, therefore, giving you constant relief from your symptoms.
I know it’s easier said than done, but don’t let your financial concerns get in the way of seeking care for yourself.
Be well, Tessa"
"Hi im 38 and i thought i was healthy until February 6...my "attack" or "episode" came out of no where. I was fine i looked down was talking...looked up and an immediate intense headache, vision & hearing loss...pain in chest & arms...the head pain was extreme. I thought i was having a heart attack. I was brought to ER & admitted..&after about a week & many tests i was diagnosed with Complete Heart Block. I received a pace maker. Thing is...i cannot figure out why...what is a complete heart block...why did it happen or what makes it happen. Why can i not find information on this condition. Is it something else. I had a low heartbrate of 22-28 Bradycardia in ER...& had been very tired and & fatigued (but this is normal for me for my life) but previous to this...i have no heart issues. Help Keli 38 Pacing Mom of 4"KDumais, Support Network Member
"Hi Kelli,Tessa Messinger, Critical Care and Clinical Research
Complete Heart Block, also called Third Degree Atrioventricular (AV) Block is an electrical disassociation between the upper and lower chambers of the heart. Just like your house, your heart has an electrical system. Imagine complete heart block is like when a wire is broken in the wall and even though you turn on the switch, the lamp doesn’t come on. So what happens in your heart, is your SA node (light switch in the top of your heart), sends out a signal to tell your heart to contract, but your AV node (lamp in the lower part of your heart) doesn’t get the signal. Luckily your body is smart enough not to leave you in the dark and the light slowly comes on, but not in coordination with the light switch, and at a much slower rate.
Complete heart block can happen for many reasons, and doesn’t mean you have heart disease. You may never know the cause of your heart block, but speak with your physician if you’d like to explore the cause or know if it is a symptom of another issue. Most importantly you sought care, and your pacemaker will keep you safe.
Here is a page from AHA, click the link to watch an animation of Heart Block.
Here is a page from WebMD that discusses a bit more about the causes of heart block.
Here’s to a happy healthy future with your 4 children.
Be well, Tessa"
"I am 50 and about 6 years ago I was diagnosed with BAV. I have been having problems with my bp recently. About a year after diagnosis my bp began to rise and ended up in the er. It has been having episodes of going higher and my Cardiologist has increased my meds and then also prescribed me water pills, which I take when needed. Recently I have been feeling light headed often and very tired throughout the day.. I am active and a physical education teacher. Could this be all because of my BAV? Does all this mean it’s getting worse. I have a yearly echo, but I’m not scheduled for this years until July. Please advise and thank you for your time."keraeason, Support Network Member
"I am assuming by BAV, you are referring to Bicuspid Aortic Valve, which is a genetic malformation of the Aortic Valve. The aortic valve is between your left ventricle (lower chamber of heart), and your aorta (large blood vessel leading from your heart to your body). It is the door from your heart to the blood vessels of your body, and regulates the flow of oxygen rich blood. Most people, yourself included, live a normal healthy life with a bicuspid aortic valve. Labile or fluctuating blood pressure is also very common with a bicuspid aortic valve. As you age, one of two things could be going on with your valve, and causing your symptoms, stenosis (narrowing), or regurgitation (back flow). This is best determined by an echocardiogram, which is an ultrasound of your heart structures.
In your circumstance, if you feel your symptoms are becoming more frequent or more severe, I would suggest calling you cardiologist and asking if you can come in sooner for you echo. Heart valve disease is a condition that does not require treatment until symptoms are frequent or severe enough to impact your quality of life. There are many treatment options for both aortic valve stenosis and aortic valve regurgitation, and that area of cardiac medicine is constantly growing. There are now less invasive options that offer the same relief and results and even 10 years ago would have required full open heart surgery.
I hope that you’re able to find answers to your symptoms, and find a great team capable of the latest technology when the time is right.
Be well, Tessa"
"Hello, I'm a father of new born boy, today he has 2 months and 13 days old, he is 58 cm and 5.5 kg. We made an Echocardiogram one month ago and it shows as main results Aortic Area was 0.19 cm2 ; speed of blood flow 5 m/s and average gradiant of 65 mm hg. Yesterday we made a 2nd Echo and we found that Aortic area is 0.3-0.4 cm2 (means increased) ; speed of blood flow is about 5,3 m/s and average gradiant of 53 mm hg. Is the increase of the Aortic Area a sign that it's better to not do any surgey now and wait to see the evolution os status by time better? Is the Aortic Surface by itself a reliable input to say that status isn't severe aortic stenosis ? How much the normal Aortic Area should be for a normal baby similar to my boy (Body Surface of 0,309 m2) ?? Please your help and advice for a worried father. Thank you in advance."Othmania, Support Network Member
"The gradient across the valve is what will drive the decision-making. With that gradient, there will likely be interest in intervention. The choices are a transcatheter balloon valvuloplasty or surgery. Which is the better option will depend on what the valve looks like (3 leaflets vs 2, etc). The aortic area will probably not be the primary determinant in when an intervention takes place. Thank you Dr. Breinholt"Dr. John Breinholt, Pediatric Cardiology
"My 6 month old son was diagnosed (echo done after a week) with a 3.4mm * 4mm perimembranous vsd at the time of birth (premature baby - 32 weeks). We did an Echo when he was 2 months old, and was told that the size of the hole had reduced to 2 mm and were asked to repeat the echo after his first birthday. During regular pediatric consultations, his pediatrician mentioned the murmur has become soft and asked us to do an echo as he felt that the VSD must have closed by itself or was about to close. So, we did an echo last week with a senior pedeatric cardiologist and were shocked to hear that the VSD has been partially closed by RCC prolapse and there is a mild Aortic valve (grade 1) leak now. He also told us that there is a mild AR and would need a surgery if the aortic valve leak increases. He prescribed digoxin and asked us to come for a follow up next month. We are struggling to recover from the shock and want to know whether surgery is the only option? Are there any symptoms that would indicate the increase in aortic valve leak? Will this be fixed by a one time surgery or will require life long medication?"TSDK1, Support Network Member
"It can happen that perimembranous VSDs can reduce in size, and rarely can close spontaneously. It is usually from tricuspid valve tissue that obstructs the defect, although in my experience, it usually only partially closes the defect. When they are small, many cardiologists choose to watch them. The one risk taken with that approach is the development of aortic valve regurgitation. In that setting, many would recommend closure before the regurgitation worsens.Dr. John Breinholt, Pediatric Cardiology
The VSD will be close with a single surgery. The outcome of the aortic valve is variable. It may not require further intervention, but that is not certain. Your child will require a lifelong relationship with a cardiologist if only to watch for any changes.
At this stage, surgery is the only option to address this problem.
Thank you, Dr. Breinholt"
"My son was recently diagnosed at 12 yrs old with PAPVR. He is scheduled to see a cardiac surgeon soon. Any help with information and connection with parents who have been faced with this would be greatly appreciated. I am scared and I am trying to learn all I can.. in what to expect... If anyone can share their experiences it would mean the world to me."Bsmall, Support Network Member
"I am unaware of any specific group for this. Most of these patients do very well. It is a relatively straightforward surgery that involves the closure of an atrial septal defect (sinus venosus) and rerouting of the pulmonary vein. The challenges typically involve where the pulmonary vein enters, and complications can involve residual narrowing of the pulmonary vein. Nevertheless, it usually goes well.Dr. John Breinholt, Pediatric Cardiology
Some centers have begun offering alternative approaches to this surgery that involve a less invasive approach that doesn’t involve a sternotomy (incision in the middle of the chest), but rather in the underarm area. One center is in Sacramento, and the other is the University of Texas HSC at Houston/Children’s Memorial Hermann Hospital where I work. This is a relatively new approach with a better cosmetic result. Thank you, Dr. Breinholt"
"What is exactly is congestive heart failure"Pfletcher490, Support Network Member
"Congestive heart failure is a broad term that describes the heart's inability to effectively or efficiently handle its function. It might be because the strength of the heart is weakened, or it might be because of a congenital defect that leads to over circulation of blood to the lungs. The definition of CHF is easier to explain depending on the heart being discussed. Thank you, Dr. Breinholt"Dr. John Breinholt, Pediatric Cardiology
"Hi there, my name is Mel and I’m 35 years old , I suffered from a stroke 1 month ago and I have just got out of the hospital. I’m looking for a bit of support and guidance getting back towards living a quality life again . Thank you for your time , Mel"MELM22, Support Network Member
"Community support is typically available in most communities to improve reintegration into society after an illness. Your hospital’s social services department will likely have a list of organizations with interest in stroke recovery in your community. If this doe not suffice, call your local American Stroke Association chapter and ask if they have any leads for community support. You should also be integrated into a rehabilitative program with the goal of returning to the previous level of engagement. Thank you, Dr. Joseph Hanna"Dr. Joseph Hanna, Neurology
"I had cardiac ablation 7 days ago. Now I'm crying and so tired. Is this normal?"frecoll22, Support Network Member
"I have had patients who have had some changes to their energy level and mood-related to sedation medication given for a procedure, but 7 days out seems a bit far unless you were taking pain medication after discharge. It is also possible that you may need some of your cardiac medications adjusted, as they were prescribed before the ablation. Make sure that you follow up with the doctor who did the procedure as well as your regular cardiologist and PCP. Thank you, Nurse Tessa"Tessa Messinger, Critical Care and Clinical Research
"I am having trouble relearning how to walk smoothly similar to before the stroke. Is this normal for most stroke survivors? dave1952 support network member"dave1952, Support Network Member
"Stroke commonly alters how survivors walk. Thankfully, recovery occurs with practice. An exercise program focusing on walking and balance will speed your recovery toward normalcy. Practice every day and hopefully your walking will again become smooth. Thank you, Dr. Joseph Hanna"Dr. Joseph Hanna, Neurology
"Why when speaking with my physicians (prime, cardio, nehp), QOL discussions rarely include anxiety, depression and isolation, why? This has got to be as important as the count of steps or grams of sodium."OneOmega, Support Network Member
"You make an excellent point. Exercise and diet are very important for managing heart disease and for ensuring a high quality of life. But social isolation, anxiety and depression are also associated with decreased quality of life and must be addressed as assiduously as lifestyle modifications. I suggest you raise these emotional concerns directly with your physicians. I don’t think they will dismiss your questions, though they may feel more comfortable referring you to a mental health professional to best address them. Be your own best advocate and bring up what most matters to you, rather than only what your physicians ask about.—Barry J. Jacobs, Psy.D., AHA volunteer, co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"Is it common for a stoke survivor to be unable to eat , not due to swallowing but due to getting the food passed her nose. She will,only take one little bite and no more. She has lost 50 lbs in 3.5 months. Also vomits at least 3 times a day, mostly just liquid"namaryvar, Support Network Member
"Most individuals after a stroke eat well. Difficulties with swallowing can be alleviated with feeding tubes positioned through the nose, mouth or directly into the stomach or intestine. This woman weight loss and vomiting are concerning for other conditions. I would take her to her primary physician as soon as possible to find the cause for her gastrointestinal plight. Thank you, Dr. Hanna"
"How do I start being a good caregiver"daughter61, Support Network Member
"That’s a hard question to answer without knowing more about your situation. But I suggest four things in general:Barry J. Jacobs, Psy.D., Clinical Psychology
1) Be a learner. Educate yourself about your loved one’s condition and prognosis by reading the AHA website and talking with the treating healthcare professionals. Knowledge is power. It will help you set expectations for what your loved one can and cannot do and the kind of help he or she may need now and in the future.
2) Be a listener. Take the time to sit with your loved one to hear her or his concerns and needs. That is more important than accomplishing any task.
3) Be flexible. You will make plans and then need to quickly revise them as medical or other conditions change. You will have to change your family and perhaps job roles. You will need to be creative and nimble
4) Be a coach. You have an important job now, not telling your loved one what to do, but helping bring out the best in her or him. That means knowing whether he or she needs a hug or a push at different times. It also means finding inspiration and motivation at times for both of you.
--Barry J. Jacobs, Psy.D., AHA volunteer and co-author of AARP Meditations for Caregivers"
"On March 16, 2019 my husband had a Hemorrhagic Stroke. The hardest part for me has been the that the man I've been married to for 38 years is now basically a stranger. Will his personality return and if yes how long will that take?"ElaineNewnum, Support Network Member
"It sounds like this has been an excruciating time for you and your family. The answer to your question can be best answered by your husband’s neurosurgeon or neurologist. They are the experts on this subject and know the specifics of your husband’s stroke. That said, hemorrhagic strokes (bleeds in the brain) generally take longer for recovery than ischemic strokes (blockages in blood vessels in the brain) because it takes months for the brain to reabsorb the blood. It is possible that your husband has much more time ahead for at least some recovery of his functions—physical, cognitive and emotions. Patience is hard to come by in such situations. You will need much patience for the next year.—Barry J. Jacobs, Psy.D., AHA volunteer and co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"My son who is 41 had 2 minor strokes affecting his short term memory. He is also a Type 1 diabetic. I’m having trouble getting him to take his medications. He thinks they changed his insulin or may think he has already taken. How can I help him. He also doesn’t thu k he has had a stroke."Jasonmattkel, Support Network Member
"When medications interactions are in question, I typically refer to two areas of expertise – the pharmacist and the specialist prescribing each medication. The patient-physician relationship is crucial to gaining compliance. The relationship is usually strongest with the physician knowing the patient the longest. You need the assistance of both his primary physician and endocrinologist. Once your son has bought into the need for compliance, a variety of tools can be used to optimize. A pill dispenser along with simplification in the dosing regimen may help in improving your son’s care. Thank you, Dr. Joseph Hanna"Dr. Joseph Hanna, Neurology
"I am a caregiver for my mother who has Congestive Heart Failure. Her weight continues to creep up and she had a weight gain of 2.9 lbs overnight. I have been well-instructed by home health nurses to call her doctor or take her to the ER if this occurs afterhours or on the weekend. Today is Sunday, and I am worried. She wants me to give her an extra Torosemide, but I feel she needs to go to the ER. She has dementia and is frequently stuboorn and intractable about going to the ER. She also suffers from COPD and Stage 111 Kidney failrure. She can tell she is retaining fluid, and acknowledged she had not been going to the bathroom, despite taking her usual dose of 2 Torosemides a day. How can I impress upon her the importance of managing these symptoms and following the advice we have been given?"BissyLewis, Support Network Member
"Being a caregiver for an elderly parent is hard on so many levels. For your whole life they have been independent and an authority figure. Once the shift happens in that you are now the authority figure, it’s a very tough line to walk. Know that sometimes you have to be the tough guy and trust your instincts to seek the best care for her. She may not want to go to the ED, but remember that her dementia can affect her logic and decision making capabilities.Tessa Messinger, Critical Care and Clinical Research
As far as her heart health, I would speak with her cardiologist on how to handle this situation in the future. Many times an extra dose of diuretic is all that’s needed to get out of the valley of fluid overload. I would ask for rules on when it would be okay to give an extra dose instead of go to the ED. What you really want to watch for and go to the ED for is any signs of difficulty breathing related to fluid overload. This would be shortness of breath or a wet sounding cough. Weight gain and decreased urination does not always necessitate an ED visit.
To impress upon her the importance of managing symptoms and following advice, I would explain that an ED visit early prevents a hospital stay later. It is far easier to intervene early with an assessment and dose of diuretic in the ED, than allow the symptoms to progress to the point of difficulty breathing requiring more advanced interventions and an admission to the hospital. It’s also critical to keep her fluid status balanced without overuse of diuretics in light of her kidney failure. So though an extra diuretic may get rid of the fluid, it could do more harm than good to her kidneys, so it’s best that a medical professional make the decision based on her labs and symptoms.
Be well, Tessa"
"How to deal with stress and not feel discourage"Wifey4ever, Support Network Member
"Feeling discouraged is certainly stressful. So what’s the best way of dealing with discouragement? There are only two paths forward—changing your situation or changing your attitude about your situation. If it’s possible to change your situation through medical means to improve your heart’s functioning, then I recommend exploring them. However, if that’s not possible and you have to live with the residual effects of heart disease or heart damage, then it is vitally important to adopt a more positive attitude. Cautious and realistic optimism is associated with less depression and better overall outcomes; pessimism tends to have the opposite effect. How can you be more positive? For many people, waking up each morning and listing the things for which they are grateful—not the least of which is the gift of life—re-frames their medical predicaments as an obstacle to get over rather than an insurmountable barrier to happiness. In other words, focus your attention on what you have and still enjoy rather than what you’ve lost. For more on positive thinking, I suggest books such as Flourish and Authentic Happiness by psychologist Martin Seligman, Ph.D.—Barry J. Jacobs, Psy.D., AHA volunteer, co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"Are heart disease and stroke related to each other? If my child has heart disease, could she have a stroke?"AHA/ASA Katie Bahn, Support Network Member
"In adults, high blood pressure, irregular heartbeat, hardening of the arteries, and diabetes can play key roles in stroke. However, this is less common in children. Children can have cardiac issues like congenital heart defects or acquired heart disease that can increase the risk of strokes. It is important for families to discuss the underlying cardiac condition and the risk of stroke with their physician.Dr. Nivedita Thakur, Pediatric Neurologist
Dr. Nivedita Thakure"
"Do children have the same stroke symptoms as adults?"AHAASAKatie, Support Network Member
"Strokes in children, especially infants and newborns, can present differently than in adults. The symptoms could be misdiagnosed with more common conditions that mimic a stroke like viral illness, migraines, or epilepsy.Dr. Nivedita Thakur, Pediatric Neurologist
-Change in mental status--Example: extreme sleepiness
-Using one side of the body more than the other
-Focal signs like weakness
-Change in mental status
-Sudden difficulty with speaking or comprehension
-Sudden vision problems
Should your child experience these symptoms, call 9-1-1 immediately."
"My baby had a stroke in utero. What are the main developmental achievements that I should look for as he grows?"AHA/ASA Katie Bahn, Support Network Member
"Monitoring development will be important, especially milestones that a baby should achieve by a certain age.Dr. Nivedita Thakur, Pediatric Neurologist
Development can be impacted by areas damaged in the brain. Thus the location and extent of injury are important factors. Another important aspect is brain plasticity. Brain plasticity can be seen in babies because the brain is developing and so different parts of the brain or an undamaged area in the same location can take over function. Therefore it is difficult to predict exactly how much difficulty a child will have in the future.
It’s important to follow development closely and get them in therapy to help practice skills they may be struggling with. This will allow the brain to use the pattern of repetition to build pathways that may have been disturbed due to the injury.
Thank you, Dr. Nivedita Thakur"
"What Causes a Pediatric Strokes in children?"AHA/ASA Katie Bahn, Support Network Member
"Strokes in children can be caused by a variety of factors:Dr. Nivedita Thakur, Pediatric Neurologist
Cardiac: Examples--Congenital heart defects or Acquired heart disease
Hematologic: Examples--Sickle cell disease or Clotting disorders
Infection: Examples--Meningitis or Encephalitis
Vascular: Examples--AVM malformation or Moyamoya
Metabolic or Genetic: Examples--Marfan syndrome or MELAS (Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes)
Trauma: Example--head and neck trauma"
"Hi all. My son had a stroke in utero or at birth... he presented with seizures during the first 36 hours of life which were controlled with phenobarbital. He's 7 months now and is doing as great as we could all hope for. Meeting his milestones and more and has no deficits or signs of stroke as of yet. We know that prognosis for this is extremely variable, which is why I'd like to hear if anyone has a similar case/ experience and what the outcome was (in regards to the area of the brain that was affected). His stroke was in his left frontal lobe, I'd say maybe 1/8th of his left side and a small part of white matter in the back of his right side... the neurologist said he is almost borderzone if that helps... I've looked at studies and patients classified as borderzone seemed to have good prognosis... but the studies are all over the map and I don't really know what to conclude at this point other than expect the worst but hope for the best. Any information from patients or parents of children with similar diagnosis would help tremendously."Support Network Member
"Thank you so much for this question. You are correct in the information you have received so far. There are 2 key aspects that we consider. The first is the location and extent of injury. The second aspect is brain plasticity. Brain plasticity can be seen in babies because the brain is developing and so different parts of the brain or undamaged area in the same location can take over function. Thus it is difficult to predict exactly how much difficulty a child will have in the future. Key aspect is following development closely and getting them in therapy to help practice skills they may be struggling with, so that the brain can use the pattern of repetition to build pathways that may have been disturbed due to the injury. I hope this helps you with what to expect in the future."Dr. Nivedita Thakur, Pediatric Neurologist
"My wife recently had her second heart attack and bypass surgery. With each event, her depression has deepened. The Drs all say it is common, but don't tell you how to deal with it. She sees a psychiatrist and therapist, but my wife just seems to exist these days. My heart is broken. She used to be so vibrant and outgoing. The weight is heavy on me also. I mean, she got a third chance at life, at being with ME, but she doesn't seem to care. I don't know how to help her any more."SandyBeaches, Support Network Member
"Depression can sap all joy, initiative and hope. It can also be very hard to remedy, despite medications and psychotherapy. Have you talked with your wife’s mental health professionals about changing her treatments to better improve her symptoms? She might benefit from a different medication regimen, alternative treatments or even a partial hospitalization or inpatient hospital stay. I also recommend that you consider contacting your local NAMI (National Association for the Mentally Ill) chapter to learn about its Family-to-Family educational program. It can teach you how you and your wife can live as well as you can with this terrible intruder in your lives—chronic depression.—Barry J. Jacobs, Psy.D., AHA volunteer and co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"I´ve been diagnosed with metabolic syndrome (thankfully with no diabetes); I´m working on my health and taking my meds; yet fear and anxiety of getting a Heart Attack invade me and sometimes give me false symptoms; how do I cope?"hgonzalez, Support Network Member
"Many people have fears about their health. Some of those fears are beyond what is warranted. When that occurs, we say they have “health anxiety.” If health anxiety becomes so distracting or overwhelming as to detract from the quality of their lives, then we recommend they see a healthcare provider--not for a physical evaluation but for an assessment of their emotional state. If you can’t push away the fear of a heart attack, then I would recommend that you see your primary care provider to be evaluated for an anxiety disorder. He or she has treatments that could be very helpful for you.—Barry J. Jacobs, Psy.D., AHA volunteer and co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"Is it normal to feel tired and depressed after a heart attack?"KimiT, Support Network Member
"Unfortunately, yes on both counts. Feeling fatigued after a heart attack may be due to decreased blood flow throughout your body, a side-effect of one of the medications you are now taking or a sign that your body is still recovering from the physical trauma of a heart attack. A fourth possibility is that the fatigue is due to the depression you may be experiencing. I suggest meeting with your primary care provider for an evaluation to help identify what cause or causes are responsible for your fatigue and depression and to consider appropriate treatments—changing your heart medication regimen, adding an antidepressant or referring you for counseling.—Barry J. Jacobs, Psy.D., AHA volunteer, co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology
"My boyfriend of over 5 years had a heart attack at the age of 27. He isn’t on any drugs just a young man with a poor diet who was chain smoker. He had his heart attack on march 9th and had 2 arties clogged. Thankfully we made in into the ER in time where he then had to get a stent placed in. I understand he is struggling with this new life style now that he has to adjust his entire life. He’s quit cigarettes cold turkey since then. But I feel that his diet and his alcohol intake could be better. I tell myself every single day that it will get better. But emotionally it’s been getting harder. I can’t stress it enough on how he should’ve be grateful that he’s able to wake up and see another day. But it kills me inside that he isn’t concern about his diet and alcohol intake. The doctor gave us specific details tht he should only have 1 beer. But. I find him drinking 4 occasionally. I can’t sleep because I am always worried about his health. I just wish that this happened to me because when it comes to health he’s very ignorant nor cares to making any adjustments with diet and finding a new job that fits his health. I can’t stress enough and I can’t stop thinking about me not being able to live with myself if another episode to recurrent."Sangpanh, Support Network Member
"Your boyfriend is very fortunate to have you in his corner. This sounds like it has been a time of crisis and change for both of you. He has changed significantly—quitting chain-smoking is a tall order—but not enough to give you the assurance he is doing all he can to safeguard his health. Rather than remind him constantly about his eating and drinking and probably make him feel like you are nagging him, I suggest two strategies:Barry J. Jacobs, Psy.D., Clinical Psychology
--Write him a hand-written letter in which you express how much you care for him and how much his health and happiness mean to you. Ask him to take better of himself for his sake and yours.
--If you don’t think that direct approach would work, then I suggest you send a letter or leave a voicemail for your boyfriend’s cardiologist to inform him about your concerns for your boyfriend’s diet and alcohol intake. Let the doctor then do the dirty work of confronting your boyfriend about his health habits.
As the Serenity Prayer says, though, you will have to ultimately accept what you cannot change. If your boyfriend is ready to do more to help himself, then he will. If he isn’t and has more health problems, it will be extremely regrettable but not your fault. Really.
Thank you, Dr. Barry Jacobs"
"I experience bipolar 2, ptsd, depression and anxiety. But what works best for depression? Because I am taking prozac for bipolar 2, but it doesn't help depression even with a higher dose"Allie117, Support Network Member
"The treatment guidelines for Bipolar II Disorder call for an antidepressant (such as Prozac) and a mood stabilizer (such as Depakote or Abilify). Using the antidepressant without the mood stabilizer won’t work nearly as well for reducing depressive symptoms. I suggest you ask your prescribing provider to review your medication regimen. You may also want to consider psychotherapy as an adjunctive therapy. I hope you feel better soon!—Barry J. Jacobs, Psy.D., AHA volunteer, co-author of AARP Meditations for Caregivers"Barry J. Jacobs, Psy.D., Clinical Psychology