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What Causes Holo-systolic Murmur In When Lying On The Right Side?

Posted on Mon, 2 Jun 2014

Question: I hear a holo-systolic murmur in my left ear when lying on the right side. I had a right carotid endarterectomy in 1985 precipitated by an episode of amaurosis fugax. No history of cardiac infarct, hypertension or medical problem except mild shortness of breath after going up one flight of stairs but no associated chest pain. Shortness of breath becoming more noticeable during the last 6 months.Smoked one pack (at least) of cigarettes daily from age 18 to age 76. I am now 79. No cough or pain on breathing. Aortic stenosis or COPD the most likely diagnosis?

Answered by Dr. Benard Shehu (7 hours later)

Brief Answer:
Possible COPD/heart failure,not aortic stenosis...

Detailed Answer:
Hi,

I have gone through your medical history carefully and understood your concerns.

Your clinical symptoms are indicative to COPD and/or heart failure, and not for aortic stenosis.

Hope it answered to your query! Let me know if you have more questions!
Dr.Benard

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

Follow up: Dr. Benard Shehu (15 hours later)

Thanks.
What is the most likely source of the holosystolic murmur

Answered by Dr. Benard Shehu (47 hours later)

Brief Answer:
Causes to holosystolic murmur...

Detailed Answer:
Hi back,

Thank you for following up.

There are many factors contributing to holosystolic murmur in your ears, including :
- heart failure
- disturbances in inner ear
- endoarterities

With regards to holosystolic murmur in your heart, it might be related to:
- stenosis of aorta
- mitral regurgitation

ENT and cardiac examinations are necessary to run to determine the right cause and take proper measures.

All the best!
Dr.Benard

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

Follow up: Dr. Benard Shehu (13 days later)

What treatment reduces peripheral diabetic neuropathy pain in feet, legs and hands?

Answered by Dr. Benard Shehu (40 hours later)

Brief Answer:
Following treatment suggestions...

Detailed Answer:
Hi back,

Thank you for following up.

The main goal in treating peripheral diabetic neuropathy is to treat the underlying conditions, so, it is extremely important to control diabetes.

Other treatment is prescribed to reduce pain:
- pain-killers (non/opioid drugs)
- anti-seizure drugs (pregabalin, gabapentin)
- anti-depressants
- capsaicin (orally or locally)
- lidocaine patches locally

Local physiotherapy is also highly recommended.

Hope it helped!
Dr.Benard

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

Follow up: Dr. Benard Shehu (26 hours later)

Thank you. Any comment on the combination therapy of local nerve block injections with bupivacaine and extenally applied electrical stimulation as described in JOURNAL OF PRACTICAL PAIN MANAGEMENT, April 2012? The anesthetic is thought to dilate neuronal capillaries and venules. The combination of electrical impulses of AM,FM and AM/FM at 2,500 to 23,000 Hz up 100mAmp adds sustained depolarization of nerve fibers to block impulses. Multiple sessions are required but many patients in the study (about 100 as I recall) report reduction, and in some cases long term pain cessation.

Answered by Dr. Benard Shehu (2 hours later)

Brief Answer:
Close evaluation by specialists is needed...

Detailed Answer:
Hi there,

When one study is being published, apart the successful results, at the end, there is always place for limitations.

Theoretically, this technique is useful. However, practically, close evaluation of the patient (in this case YOU) should be considered.

So, if you want to try this technique, should consult a neurologist. Sit with him/her and discuss over the benefits, side effects and outcomes. If you are really convinced that this technique has more beneficial outcomes than side effects, you can try it.

All the best!
Dr.Benard

Note: For further queries related to coronary artery disease and prevention, click here.

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