expert type icon EXPERT

Dr. Toby Paulson

Cardiologist

Dr. Toby Paulson is a cardiologist practicing in Payson, Arizona. Dr. Paulson specializes in diagnosing, monitoring, and treating diseases or conditions of the heart and blood vessels and the cardiovascular system. These conditions include heart attacks, heart murmurs, coronary heart disease, and hypertension. Dr. Paulson also practices preventative medicine, helping patients maintain a heart-healthy life.
Dr. Toby Paulson
  • Payson, Arizona
  • Ohio University
  • Accepting new patients

When should one choose angioplasty over a bypass surgery?

This is tough with out seeing the coronary anatomy and knowing background information such as age, gender and hx of diabetes. Generally speaking if the LAD main artery is involved READ MORE
This is tough with out seeing the coronary anatomy and knowing background information such as age, gender and hx of diabetes. Generally speaking if the LAD main artery is involved and there are at least one or two other vessels involved then bypass is often a better choice in the long run. This is a generalization and should be discussed with the surgeon and your cardiologist.

My father has been diagnosed with myocarditis. What does this mean?

Myocarditis is inflammation of the heart muscle. This is usually self limiting but can be treated depending on the underlying cause of the myocarditis. Myocarditis can be caused READ MORE
Myocarditis is inflammation of the heart muscle. This is usually self limiting but can be treated depending on the underlying cause of the myocarditis. Myocarditis can be caused by infections viral most commonly or bacterial. Other causes or often autoimmune causes or direct trauma to the heart muscle.

What is cardiac catheterization?

Cardiac catheterization or coronary angiography is a procedure that involves placing a catheter through an artery in either the radial artery or femoral artery and passing it through READ MORE
Cardiac catheterization or coronary angiography is a procedure that involves placing a catheter through an artery in either the radial artery or femoral artery and passing it through the arteries back to the heart. The catheter is then placed into the coronary arteries and a contrast agent is then passed into the arteries so the lumen of the coronary arteries can be visualized to see if a stent or bypass is needed. I can't speak for your cardiologist but in general this is a very safe procedure and patients are comfortable throughout the procedure.

My mother has been experiencing frequent heart palpitations. What could be causing this?

There are many types of palpitations. If they are severe enough that they are stopping her in her tracks then a heart monitor or ECG should be done to evaluate She should go READ MORE
There are many types of palpitations. If they are severe enough that they are stopping her in her tracks then a heart monitor or ECG should be done to evaluate She should go to her PCP to discuss the symptoms and have heart monitor for further evaluation.

Can angioplasty cause breathlessness?

Angioplasty usually does not cause breathlessness. One of the medications we use after placing a stent has been associated with episodes of brief shortness of breath lasting a READ MORE
Angioplasty usually does not cause breathlessness. One of the medications we use after placing a stent has been associated with episodes of brief shortness of breath lasting a few breaths. I would recommend following up with your cardiologist to review medications, and make sure his kidney function is stable after the procedure.

My mother is suffering from breathlessness but the 2-d echo shows normal. Why?

A 2-D echocardiogram will show you structure, heart strength (Ejection Fraction), its ability to relax (diastolic function) and pulmonary pressure. The echocardiogram will only READ MORE
A 2-D echocardiogram will show you structure, heart strength (Ejection Fraction), its ability to relax (diastolic function) and pulmonary pressure. The echocardiogram will only be abnormal if she has had damage to the heart muscle that is limiting it's ability to pump or with active blockage (ischemia). To further evaluate for other causes of shortness of breath, she could undergo stress testing to evaluate for inducible ischemia as a cardiac cause, will also show if she is having abnormal heart rhythm with exertion. I often will also send my patients for pulmonary function testing if no other signs of cardiac causes are identified.

What is the difference between a bypass surgery and an angioplasty?

Blockages can be obstructive, more than 75-80% of the inside diameter of the coronary artery or less than 75%. If it is more than 75%, then the options are angioplasty which usually READ MORE
Blockages can be obstructive, more than 75-80% of the inside diameter of the coronary artery or less than 75%. If it is more than 75%, then the options are angioplasty which usually means placing cardiac stents into the arteries to open the blockage up and allow blood to flow through the artery again. This is done through a cardiac catheterization.

A bypass surgery is an open heart surgery where a surgeon opens your chest up and uses veins and/or arteries from other places in your heart to bypass or go around the blockages to supply blood to the areas of the heart past the blocked arteries.

Is pleurisy a disease? How long does a pleuritic chest pain last?

Pleurisy is a condition of the lungs. It is an inflammation of the pleural lining around the lungs. It can be viral, bacterial or caused by chemical exposures. It may last a couple READ MORE
Pleurisy is a condition of the lungs. It is an inflammation of the pleural lining around the lungs. It can be viral, bacterial or caused by chemical exposures. It may last a couple of days or much longer, depending on the cause and treatment. Usually, anti-inflammatory medications at high doses are used initially for the inflammation. If the pain continues to worsen or starts to affect your ability to do activity or is associated with fever, then you should be seen sooner than later.

My father suddenly has symptoms like sweating and uneasiness. Could it mean something?

These symptoms can be associated with different causes. If he continues to have symptoms following meals, it could be related to gastric ulcers or heart arrhythmias. Next time READ MORE
These symptoms can be associated with different causes. If he continues to have symptoms following meals, it could be related to gastric ulcers or heart arrhythmias. Next time he has these symptoms, check his pulse and blood pressure as soon as possible.

Is heart palpitation a normal feeling or is it a medical concern?

Heart palpitations are normal for most people. An average person can experience up to 1% of their normal heart beats to be abnormal. That being said there are normal palpitations READ MORE
Heart palpitations are normal for most people. An average person can experience up to 1% of their normal heart beats to be abnormal. That being said there are normal palpitations and abnormal palpitations. Based on description of the palpitations we can make a very strong guesstimate of what your palpitations are. If you have concerns you can see a cardiologist or your primary and ask them to do an ECG and a holter monitor. If you don't want to waste time you can go online and purchase a device called AliveCore Kardia. This device will link to your smartphone and make a recording of your heart rhythm not just tell you the rate. Once you have recording of your episodes cardiologist can tell you more accurately if your palpitations are concerning or not.
I would rather you error on the side of caution and get checked than to ignore symptoms

Is my heart skipping beats?

Most likely, this represents a Premature Ventricular Contraction (PVC or VPC), these represent early electric excitation from the bottom of the heart which then blocks the normal READ MORE
Most likely, this represents a Premature Ventricular Contraction (PVC or VPC), these represent early electric excitation from the bottom of the heart which then blocks the normal contraction of the heart. During this time, the normal beat is blocked and the heart continues to fill with blood. The next heart beat follows this absence of contraction which is the skipped beat sensation and the next beat is a ventricle with extra blood which often is a more forceful beat that can often take your breath away or be felt into the stomach.

Hope this helps.

Gum disease and heart disease

There is a strong link between periodontal/gum disease and coronary artery disease. There are many factors taht link periodontal/gum disease and CAD/CVSD. Periodontal infections/inflammation READ MORE
There is a strong link between periodontal/gum disease and coronary artery disease. There are many factors taht link periodontal/gum disease and CAD/CVSD. Periodontal infections/inflammation trigger a systemic inflammatory disorder leading to increasing inflammation in the coronary and cerebrovascular arteries, as the inflammation continues the amount of inflammation in the vessel lumen increase leading to increased arterial plaque formation. In addition post periodontal infections are caused by gram negative bacteria which cause release of endotoxins which alter lipid metabolism and increase inflammatory mediators.

Dental plaque is not the same as plaque in the heart arteries.

Is chest heaviness related to my past heart issues?

Chest pressure may be related to new heart blockage or could be related to other problems arising. Typically once you have had a heart attack you will continue to experience the READ MORE
Chest pressure may be related to new heart blockage or could be related to other problems arising. Typically once you have had a heart attack you will continue to experience the same discomfort as when you presented the first time. I would recommend proceeding with cardiac testing since you have a history of heart problems.