Arthur E. Constantine, M.D.

The report describes a patient who has peripheral atherosclerosis in the carotid arteries, which shows a stent placed in the past (presumably bc of a severe blockage). The end of the stent has slowly over time had development of another narrowing of significance in the stent, which allowed collaterals from another vessel to develop adequate flow to support the area supplied by the previously stented carotid. Because of the collaterals, one may not have symptoms.
 
Dr. Arthur Constantine 

Yes! Strokes come in various severity and I have seen many examples of patients who have had various severities live a long, fruitful, and joyful life! Many people have had strokes with complete recovery. When diagnosed with a stroke at a young age like you it is important to rule out a cause that can be corrected to prevent further strokes. And it is important to stay active and with enthusiasm go through the rehabilitation to recover as much of the decreased motor skills that were impacted from this stroke.

And remember your testimony to others of what you went through yet still show the joy and peace that comes from Jesus Christ can be a comfort and encouragement to others who have suffered the same attack yet felt they were all alone and life was over. That testimony can be powerful. Stay upbeat and physical and spiritual healing can be yours!!!


Arthur E Constantine M.D.

Usually the symptoms of chest pain, pressure, or heaviness that recur years after a heart attack will be very similar to the symptoms that were present at the time of the heart attack although likely not as severe. Chest pain that are related to the heart - angina - that occur years later usually start out with exertion, described as a pressure, heaviness, or tightness on the left side of the chest and are relieved by rest or sublingual nitroglycerin, however this is not always the case. If the symptoms are worsening, even if not quite similar to the prior chest discomfort, they should not be ignored. The non cardiac reasons of chest discomfort are multiple and not the scope of the cardiologist and in most cases should be evaluated by your primary care doctor. To lessen the chances of further heart problems including another heart attack or procedure related to worsening heart blockages, one must strictly adhere to modification of lifestyle by exercising 30-60 minutes daily and following a nutritious low fat, low cholesterol diet on a daily basis.

Yes it is possible to have MVP without a heart murmur as MVP is a disease of the tissue of the valve that results in a thickening and redundancy of the valve leaflets which "bow" like a parachute upon closing. This may result in a sound called a "click", which is very hard to hear on exam and most of the time is not present. The valve may or may not leak and therefore a murmur may or may not be heard. Even in the presence of a valve that leaks, a murmur may not be heard or could be very soft making it difficult to hear.

If you had an echo 6 yrs ago that was normal, the likelihood that mitral valve prolapse (MVP) is present is extremely low provided the echo was of good quality at that time. If so, I would not repeat the echo at present just to reevaluate for MVP.