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Light Headedness, Dizzy, Gasping For Breath, Clammy, Pins And Needles In Hand, Cellulitis In Leg. History Of Stroke. Concerned
Question: Hi I am a registered nurse and concerned for my grandad
The question is about my grandad.
He is 83
Medical History
Stroke August 2012 (right side facial drop and loss of grip in right hand, facial droop resolved.).
Cellulitis right leg (leg remains at risk of ulceration, has oedema, washing and applying creams and elevating)
Diagnosis of AF and bradycardia
Average blood pressure is 140/65 pulse 40-55 (lowest reading today
Monitor shows irregular heartbeat symbol frequently
Current symptoms
Having frequent periods of light headedness and describing having to take a large breath to help with the episode and feeling feeling dizzy. He has described it as like gasping for a breath and chest feeling strange. He gets clammy. The episode only last a few minutes and then he comes round. He also states he feels pins and needles in his right hand.
Loss of use in right hand
Cellulitis right leg
Medication
Just started warfarin 3mg
Ramipril at night
Simvastatin
Antibiotics for cellulitis
Dermovate cream
The question is about my grandad.
He is 83
Medical History
Stroke August 2012 (right side facial drop and loss of grip in right hand, facial droop resolved.).
Cellulitis right leg (leg remains at risk of ulceration, has oedema, washing and applying creams and elevating)
Diagnosis of AF and bradycardia
Average blood pressure is 140/65 pulse 40-55 (lowest reading today
Monitor shows irregular heartbeat symbol frequently
Current symptoms
Having frequent periods of light headedness and describing having to take a large breath to help with the episode and feeling feeling dizzy. He has described it as like gasping for a breath and chest feeling strange. He gets clammy. The episode only last a few minutes and then he comes round. He also states he feels pins and needles in his right hand.
Loss of use in right hand
Cellulitis right leg
Medication
Just started warfarin 3mg
Ramipril at night
Simvastatin
Antibiotics for cellulitis
Dermovate cream
Hi,
Thanks for writing in.
As per the history of your grand dad, his symptoms may be of cardiac origin. As his heart rate is about 40-55, Some times, such a situation would be due to some heart blocks. To rule this out, we should do a repeat ECG and echocardiography.
As he is a case of AF on warfarin, a ECG would be recommended in this situation as well. Please get a ECG done and upload the reports. After that, 1e can take this discussion ahead.
Good luck ...
Thanks for writing in.
As per the history of your grand dad, his symptoms may be of cardiac origin. As his heart rate is about 40-55, Some times, such a situation would be due to some heart blocks. To rule this out, we should do a repeat ECG and echocardiography.
As he is a case of AF on warfarin, a ECG would be recommended in this situation as well. Please get a ECG done and upload the reports. After that, 1e can take this discussion ahead.
Good luck ...
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Hi Dr
Thank you for your last response.
I did as you advised and got an ECG. I have uploaded the report.
Since I last spoke to you,
My Grandad continues to have the episodes of feeling light headed and needing to take a XXXXXXX breath. They dont last long. On Days like this he appears pale in colour, and a little vacant looking. He describes having pins and needles in his hands. he has 4-6 episodes per week that I am aware of.
Regarding his R leg, he has had more antibiotics and they seem to have worked. The redness has subsided and risk of ulceration is reduced. My Grandad rests at home with legs and right hand elivated. If he walks for a perod of time, goes to a hospital appointment or something similar, his right leg and right hand get swollen. It then reduces with elevation.
Today his BP and pulse today 169/79 38bpm and 104/69 59bpm
He has an Echo booked this Friday 31/08/2012
He has an appointment for 24 hour ECG but not until October.
Please can you help me understand the severity of the condition and what my Grandad maybe at risk of?
I hope the ECG helps and Thank you for all your help in this matter.
He is now on 2mg of Warfarin daily
Thank you for your last response.
I did as you advised and got an ECG. I have uploaded the report.
Since I last spoke to you,
My Grandad continues to have the episodes of feeling light headed and needing to take a XXXXXXX breath. They dont last long. On Days like this he appears pale in colour, and a little vacant looking. He describes having pins and needles in his hands. he has 4-6 episodes per week that I am aware of.
Regarding his R leg, he has had more antibiotics and they seem to have worked. The redness has subsided and risk of ulceration is reduced. My Grandad rests at home with legs and right hand elivated. If he walks for a perod of time, goes to a hospital appointment or something similar, his right leg and right hand get swollen. It then reduces with elevation.
Today his BP and pulse today 169/79 38bpm and 104/69 59bpm
He has an Echo booked this Friday 31/08/2012
He has an appointment for 24 hour ECG but not until October.
Please can you help me understand the severity of the condition and what my Grandad maybe at risk of?
I hope the ECG helps and Thank you for all your help in this matter.
He is now on 2mg of Warfarin daily
Hi,
Thanks for writing back.
I have gone through all the details you have sent and definitely in this situation its difficult to manage. As per the ECG, a heart block is ruled out, but due to the poor quality of the image, it would be difficult to rule out atrial fibrillation, which could be responsible for his symptoms. As his Echocardiography is planned on 31.8.2012 please send me the report afterwards. With echocardiography report, we can get some guidelines regarding further treatment. He needs to continue with warfarin as usual.
Best
Dr Mandal
Thanks for writing back.
I have gone through all the details you have sent and definitely in this situation its difficult to manage. As per the ECG, a heart block is ruled out, but due to the poor quality of the image, it would be difficult to rule out atrial fibrillation, which could be responsible for his symptoms. As his Echocardiography is planned on 31.8.2012 please send me the report afterwards. With echocardiography report, we can get some guidelines regarding further treatment. He needs to continue with warfarin as usual.
Best
Dr Mandal
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Hi Dr
Sorry about the quality of the image.
On the report it does state "atrial fibrillation with slow ventricular response.
Please can you explain what this means.
I wil upload echo once done
Thank you
Sorry about the quality of the image.
On the report it does state "atrial fibrillation with slow ventricular response.
Please can you explain what this means.
I wil upload echo once done
Thank you
Hello ..
There are 4 chambers in the heart. The right and left atria and the right and left ventricle. Normally, an electrical impulse originates in the SA node in the atrium and travels down to the ventricle which then contracts and pumps blood to the whole body. When the impulse does not begin in the SA node and instead in or near the atria a large number of times, the atria start contracting very fast.This condition is called atrial fibrillation.
Few impulses passes to ventricle according to that ventricle contracts. In this case ventricular rate is good.
So continue medication ... Send the report after echocardiography ...
Best
There are 4 chambers in the heart. The right and left atria and the right and left ventricle. Normally, an electrical impulse originates in the SA node in the atrium and travels down to the ventricle which then contracts and pumps blood to the whole body. When the impulse does not begin in the SA node and instead in or near the atria a large number of times, the atria start contracting very fast.This condition is called atrial fibrillation.
Few impulses passes to ventricle according to that ventricle contracts. In this case ventricular rate is good.
So continue medication ... Send the report after echocardiography ...
Best
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Aparna Kohli
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