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Q. My heart was fine 12 months ago. Suddenly, I developed too many problems. Why?

Answered by
Dr. Mahmoud Ahmed Abelrahman Abouibrahim
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 18, 2018

Hello doctor,

I am a 24 year old female who has celiac disease and was recently diagnosed with cardiomyopathy, a left bundle branch block (starts I believe when my pulse gets above 80). I had atrial flutter and had an electrophysiology study, where they ablated some arrhythmias, and during the procedure, I went into atrial fibrillation and required cardioversion to fix it. They have also told me that I have left ventricular dysfunction that is causing heart failure. I also got a cardiac implant that records my heart but is not a pacemaker or defibrillator. My heart was completely fine twelve months ago. I had an EKG that showed no problems. Then towards the end of last year, I developed all of the above-stated problems. Recently I have been feeling quite sick and these are my symptoms:

  • Sensitivity to sound.
  • Lots of ringing and roaring in the ears.
  • Dry eyes.
  • Dry mouth.
  • Very sore joints.
  • Exhausted.
  • Light-headed.
  • Chest bubbles/fluttering.
  • Bad memory.
  • Diarrhea/constipation (causing bleeding).
  • Tremors.
  • No appetite.
  • Significant pain in armpits.
  • Sore neck.
  • Night sweats.

My main medical care is through Veterans Affairs. So, any possible answers would be greatly appreciated.

Dr. Mahmoud Ahmed Abelrahman Abouibrahim

General Medicine Internal Medicine


Welcome to

I understand all your concerns. From what you mentioned, the medications that you take for the heart failure like the diuretics may be responsible for the great majority of your symptoms like the dry eyes, the ear problem, sore joints. So, I suggest that you tell me all your drug list and send the last echocardiography report.

Any investigations you performed would be helpful. I recommend that you follow up as your case is quite debatable.

Revert with more information to an internal medicine physician online -->

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Thank you doctor,

I do not take any diuretic. The only cardiac-related medication I take is 100 mg of Metoprolol. The only other medications I take are Protonix for GERD, Tramadol for pain 100 mg extended release, and bc. But neither the dosages or medications have changed, anytime near when the newer symptoms started. I cannot scan at the moment but this is what it says. I will summarize the sections where it really only says it is normal.

  • Left ventricle: The left ventricle is normal in size. There is normal left ventricular wall thickness. Left ventricular systolic function is mild to moderately reduced. Ejection Fraction = 35 -45%. Septal motion is consistent with conduction abnormality. There is moderate posterior wall hypokinesis.
  • Right ventricle: Normal size, normal function.
  • Atria: Left and right atrial size is normal.
  • Mitral valve: Normal. No mitral valve stenosis. There is trace mitral regurgitation.
  • Tricuspid valve: Valve is normal, no stenosis. Trace tricuspid regurgitation. IVC is normal in size and collapses <50%. Right ventricular systolic pressure is normal.
  • Aortic valve: No stenosis. No regurgitation.
  • Pulmonic valve: The pulmonic valve is not well visualized.

Dr. Mahmoud Ahmed Abelrahman Abouibrahim

General Medicine Internal Medicine


Welcome back to

Thanks for your follow up. I have checked all the data provided (attachment removed to protect patient identity) and here is my comment:

Regarding the symptoms you have, they fit the side effects of Tramadol. So, I would like to know how much do you take per day? And I suggest that you reduce the dose gradually.

In order to be able to give you advice about the other options of pain management, I need more information about why you take it. As for the echo report, it shows everything is normal except some hypokinetic segments and the general pump function is moderately reduced and that means you have a moderate heart degree which requires some medications like low dose ACEI (Ramipril 1.25 mg) and a low-dose diuretic (Torsemide 5 mg).

Do you have any lower limb edema or dyspnea on mild effort? If yes, please send me some photos of the lower limbs in order to identify the degree. Metoprolol is suitable but not enough.

For more information consult an internal medicine physician online -->

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