Reader: I am a woman in my upper 60s and for years have had a faster-than-usual pulse, sometimes when I am at rest. Also, I have irregular beats that make me uncomfortable. I have seen a heart specialist who took an EKG but said it was nothing to worry about and that it was a "woman thing." Should I ignore the irregularities or seek another opinion?

Dr. Zipes: There is an entity called "inappropriate sinus tachycardia" characterized by faster-than-normal beating of the normal pacemaker of the heart. This makes the EKG look normal, except for the faster rate. For unknown reasons it occurs more commonly in women than men, which may have prompted your doctor's remark. The irregular beats may be related to the same disorder. I would recommend that you be evaluated by an electrophysiologist, a heart doctor with additional training in heart rhythm problems who should be able to diagnose your problem and treat it, if necessary.

Premature Beats

Reader: I developed premature beats from the top and bottom chambers of my heart about four years ago at age 45, several months after worrying about my husband's illness (he received two stents) and stopping smoking. I get about 50 a day, and they make me feel very nervous and scared. All tests check out fine. I take Sectral twice daily, which helps but doesn't eliminate all of the thumping. My questions are: How common is this, is there any reason, and will they go away?

Dr. Zipes: Premature beats as you describe are quite common in normal healthy individuals, particularly as they age, and tend to increase the older you get. As I have said before, the heart is not a Swiss watch and beats irregularly on occasion. It is likely that you will experience them from time to time for the rest of your life. However, in the setting of an otherwise normal heart--you said all tests checked out fine--they are only significant in that they make you feel uncomfortable. In your case, they should not be associated with an increased risk of heart attack, stroke, or death, and the best thing you can do is to learn to live with them. The most important thing you have done, however, is to have stopped smoking! Do not start again.

Walnuts and Cholesterol

Reader: In the November/December issue of The Saturday Evening Post, walnuts were mentioned to lower total and LDL cholesterol. Eating raw walnuts makes my tongue develop welts, so I avoid them. However, we sauté all vegetables and meat in olive oil or walnut oil. Would walnut oil be beneficial for me? My total cholesterol is 240, HDL 49, and LDL 120.

Dr. Zipes: Walnuts and walnut oil are good sources of two essential unsaturated fatty acids, alpha-linolenic acid and linoleic acid, along with plant protein and other important vitamins and minerals. In various studies they have been shown to reduce triglycerides, total cholesterol, and LDL (bad) cholesterol and to elevate HDL (good) cholesterol. However, your total cholesterol is too high, as is your LDL. Dietary changes alone may be insufficient to reduce your lipids to the normal range. You should check with your doctor about further evaluation and whether you should be taking a medication to reduce those values if they do not return to a normal range. If you like eating the walnuts, one suggestion is to soak them in water for three to four hours, discard the water, and repeat the process several times. That procedure may rid the walnuts of their toxic effect on your tongue.

Recurring A-fib

Reader: I am 70 years old and lave been cardioverted for atrial fibrillation three times. Each time I physically exert myself, the atrial fibrillation recurs. Recently I went swimming and it flared up again. I have been probed, prodded, x-rayed, and tested in every fashion, and the doctors cannot come up with any reason why the atrial fibrillation restarts. Do you have any suggestions for next steps I can take to cure or at least control these episodes?

Dr. Zipes: There is a type of atrial fibrillation precipitated by physical activity, which appears to be what you have. You don't describe any drugs you have tried, but sometimes drugs that block the adrenaline effect of exercise, called beta blockers, can be effective, since it is thought that the adrenaline action on the heart may be the cause. Other drugs can be tried also. A more aggressive approach is what is called catheter ablation, an invasive procedure somewhat resembling a heart catheterization. During this procedure, the area in the heart causing the atrial fibrillation is located and isolated or destroyed by energy delivered over the catheter. Success rates for a cure vary, but are in the range of 65 to 90 percent, depending on the type of atrial fibrillation and the experience of the doctors. I would suggest that you also contact an electrophysiologist for a complete evaluation and explanation of the various options open to you.