Do I have a weak heart?

Question

Whenever I hold my hand above my head in any way (not even straight up... I can just be sitting with my hands behind my head) I start to lose blood flow to my hands that I can really feel. This sensation of an absense of circulation forces me to put my hands back down after only a minute or so. This same thing also happens when I'm lying down and my hands are above my head (parallel to the ground). Does this happen to everyone or is it specific to me?

Answer 1

That is completely normal hon,nurse for 5 yrs working on my B.S.N in nursing now.I decided to add more info to comment due to the answers underneath me,this is completely normal and when I emailed my instructor who has over 23yrs in the medical field he totally agreed with me.He said the TOS everyone is talking about you would definatly know if it was that because it makes you barely able to function on a daily basis.To me it doen't seem like you have a weak heart maybe some sort of ciculatory problem of some sort.Definately not a weak heart.I've study and worked with the best in the trauma unit at GW in Washington,DC as well as Howard University Hospital.Go and talk to your primary care physician and see what he or she has to say about this issue.

Answer 2

Hi Johndoe. I must disagree with the nurse, this is not normal. You are describing classic signs for a fairly common (but rarely diagnosed) condition called Thoracic Outlet Syndrome (TOS). The hand positions you describe and the resulting loss of blood flow is reproducing an orthopedic medical test called the "hyperabduction test" that is used to evaluate TOS.

TOS involves compression of the neurovascular bundle (nerves, arteries and lymphatics) as they pass through the muscles of the lower neck (the scalene muscles), through the shoulder girdle, and into the arm. There are a variety of places/ways the artery, nerves, and/or lymphatics can become 'entrapped' along this path. The hyperabduction test suggests the entrapment is occurring as the artery passes under the insertion point of the Pectoralis Minor muscle. This often is the result of trigger points in the muscle (causing it to shorten/tighten) and can also be caused by spinal subluxations in the neck (causing irritation of the nerve to the Pectoralis muscles - the nerve comes from the neck).

TOS is often the long-term consequence of a whiplash type of injury (auto-accident, sports injury, fall, etc.). A good Chiropractor can often do a lot of good for this type of problem.

Best wishes and good luck.

Answer 3

Dr Madgy Yacoub, well-known cardiac health practitioner of Egyptian starting place particularly did that on a touch lady, and gave her threat to boost untill she became 11 before he could eliminate the transplanted heart. this may also be accomplished by technique of creating use of prosthetic kit (cardiac help gadgets), that help the middle to pump, dump the stress on it, and substances it a threat to heal.

Answer 4

No you don't have a weak heart, but most of our doctors forget the persistent cervical rib syndrome and you know a mixture of TOS is labeled . We are all students of knowledge, here is an article which I have searched out for you to read and understand the nature of your disease:

Definition



Thoracic Outlet Syndrome (TOS) is pain, numbness, tingling, and/or weakness in the arm and hand due to pressure against the nerves or blood vessels that supply the arm. It is due to tight muscles, ligaments, bands, or bony abnormalities in the thoracic outlet area of the body, which lies just behind the collar bone. Pressure on the nerves is the problem more than 95% of the time, but occasionally the artery or vein is involved.


Common Symptoms


The most frequent complaints are numbness and tingling in the fingers; pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and dropping things from the hand; worsening of the symptoms when elevating the arm to do such things as comb or blow dry one's hair or drive a car; and coldness and color changes in the hand. The symptoms are often worse at night or when using the arm for work or other activities. During the year 2005, we have become aware of a large number of patients who, in addition to these symptoms, also have pain in the anterior chest wall, just below the collar bone along with pain over the shoulder blade. Until recently it was thought that these later symptoms were also due to TOS, but now it has been learned that they are due to a condition frequently accompanying TOS, namely pectoralis minor syndrome.


Cause


TOS is most often produced by hyperextension neck injuries. Auto accidents that cause whiplash injuries, and repetitive stress in the workplace, are the two most common causes. Some of the occupations that we see causing TOS include, working on assembly lines, keyboards, or 10-key pads, as well as filing or stocking shelves overhead. In some people, symptoms develop spontaneously, without an obvious cause. An extra rib in the neck occurs in less than 1% of the population. People born with this rib, called a "cervical rib", are 10 times more likely to develop symptoms of TOS than other people. However, even in men and women with cervical ribs, it usually requires some type of neck injury to bring on the symptoms. Pectoralis minor syndrome appears in more than half of the patients who have TOS. It results from the same type of injuries that cause TOS.


Diagnosis


Physical examination is most helpful. Common findings are tenderness over the scalene muscles, located about one inch to the side of the wind pipe. Pressure on this spot causes pain or tingling down the arm. Rotating or tilting the head to one side causes pain in the opposite shoulder or arm. Elevating the arms in the "stick-em-up" position reproduces the symptoms of pain, numbness, and tingling in the arm and hand. There is often reduced sensation to very light touch in the involved hand (this can only be detected in people with involvement on one side).

In addition to these findings on physical examination of patients with TOS , patients with pectoralis minor syndrome have point tenderness just below the collar bone about an inch or two inside the shoulder (biceps tendon). Pressure on this spot often causes pain and tingling down the arm.


Diagnostic tests, such as EMG's or NCV's, may show non-specific abnormalities, but in most people with TOS, these tests are normal. However, during 2005 we have found a new nerve test which has been abnormal in the large majority of TOS and pectoralis minor syndrome patients. This test can be considered a variation of EMG/NCV measurements. It is a determination of the medial antebrachial cutaneous nerve (abbreviated MAC). We are currently in the process of reporting our findings in one of the medical journals and hope to have it published sometime in 2006 or 07. It is one of the few objective tests that can support the diagnosis.

Neck or chest x-rays may show a cervical rib. Loss of the pulse at the wrist when elevating the arm or when turning the neck to the side (Adson's sign), has been thought by some to be an important diagnostic sign. However, we find it unreliable because many normal people also lose their pulse in the same positions, and the majority of people with TOS do not lose their pulse in these positions. Shrinkage of hand muscles (atrophy) occurs in about 1% of people with TOS, and these people will have nerve tests that show a typical pattern of ulnar nerve damage.

Other diagnostic tests that are helpful are a scalene muscle block for TOS and a pectoralis minor muscle block for the pectoralis minor syndrome. These are simple office tests that involve a 15 second injection of novicaine or xylocaine into the anterior scalene or pectoralis minor muscle. The tests give strong support to the correct diagnosis if within a minute of two of the injection there is good relief of symptoms and improvement in physical exam findings.


Disease Process


Microscopic examination of scalene muscles from the necks of people with TOS demonstrates scar tissue throughout the muscle. Presumably, this was caused by a neck injury stretching these muscle fibers. The tight muscles then press against the nerves to the arm (brachial plexus) producing the hand and arm symptoms. Neck pain and headaches in the back of the head may be caused by the tightness in these muscles but also can be the result of stretching muscles and ligaments along the cervical spine of the neck in cases of whiplash injury.


Treatment


Treatment begins with physical therapy and neck stretching exercises. Abdominal breathing, posture correction, and nerve glides, carried out on a daily basis, are a part of the therapy program. Gentle, slow movements and exercises are stressed. Methods like Feldenkrais have helped many people with TOS. Modalities to avoid are those that emphasize strengthening exercises, heavy weights, and painful stretching. It is important to be examined and tested for other causes of these symptoms because other conditions can coexist with TOS, and these should be identified and treated separately. Some of these associated conditions include carpal tunnel syndrome, ulnar nerve entrapment at the elbow, shoulder tendinitis and impingement syndrome, fibromyalgia of the shoulder and neck muscles, and cervical disc disease. Surgery can be performed for TOS, but it should be regarded as a last resort. Non-surgical forms of treatment should always be tried first.


Surgical Treatment

Surgery for TOS is designed to take pressure off the nerves to the arm. This can be achieved by removing the muscles that surround the nerves (scalene muscles), by removing the first rib, or by doing both (removing muscles and first rib. Over the past 30 years we have employed each of these 3 operations in a quest for the safest and most effective procedure. All 3 procedures( transaxillary first rib resection, scalenectomy, and combined rib resection and scalenectomy) have limitations; there is no perfect operation. When we analyzed our results for the 1990's, it was observed that the failure rate for scalenectomy with rib resection or without rib resection was the same. This has led us to use scalenectomy without rib resection as our operation of choice. However, when during the operation we observe the nerves to the arm being pressed by the first rib, we will remove the rib during that operation. In the year 2004, during which time over 100 operations were performed, the first rib was removed in 7 patients.

Recurrent symptoms of pain, numbness and tingling is most often the result of scar tissue formation during the healing period. This occurs regardless of which operation is performed. During the past 4 years, 2002 through 2005, we have covered the nerves to the arm with a material like Saran Wrap or more recently, by a material like cellophane, that is designed to reduce scar tissue adhering to the nerves after surgery. The material is totally absorbed within months so there is no foreign body remaining. The material has now been employed in over 350 patients and, to date, the failure rate has been reduced, although not eliminated.

In 2005 we became acquainted with a condition that was described 60 years ago but which most of us had ignored, the pectoralis minor syndrome (described above under "cause" and "diagnosis"). Each patient we now see for TOS is also examined for this. We have been surprised to find that at least half the people who have TOS also have complaints and positive physical exam findings of pectoralis minor syndrome. If following a pectoralis minor block these is significant improvement within a few minutes, we have been performing a very simple operation called pectoralis minor tenotomy. This operation is performed through a 3 inch incision in the arm pit. The pectoralis minor muscle is easily found and cut at its attachment to the shoulder blade (at the coracoid process). One inch of the muscle is then removed to prevent it's reattachment to the top of the nerves going to the arm. The incision is closed with buried stitches. The operation usually takes less than 30 minutes and can be performed as an outpatient. The procedure carries almost no risk of injury.

In 2005, we performed over 50 pectoralis minor tenotomies as the only operation. 35 of these were performed in patients who previously had been operated upon by scalenectomy or first rib resection. They had experienced partial improvement in their symptoms from their operation but continued to complain of pain in the chest and pain over the shoulder blade. Separately, 16 pectoralis tenotomies were performed on patients who had not been operated upon previously. They had been seen because it was thought they had TOS. On exam, most of them did indeed have TOS, but also had findings of pectoralis minor syndrome. When their symptoms and findings on physical exam were dramatically improved by a pectoralis minor block, they were offered the simple operation of pectoralis minor tenotomy with the understanding that if they did not experience good relief of their symptoms they could return for the bigger operation of scalenectomy or first rib resection. To date, 2 patients have returned and received scalenectomies. The other 14 have had so much improvement that consideration of additional surgery has not been necessary.


Results of Treatment


Most people with TOS will improve with stretching and physical therapy. In our experience with over 5000 people with TOS, less than 30% had surgery. The improvement rate with surgery varies with the cause of the TOS. Auto injuries have a success rate of about 80% while repetitive stress at work has a success rate of 65-70%. Pectoralis minor tenotomy has only been performed for the past year. The success rate to date is between 80 and 90%.