Ask Dr. Zipes
Health risk concerns
By Douglas Zipes, M.D.
From the March/April 2006 Issue
Reader: Twice I have worn a heart monitor for three to four days. Both tests showed a rapid heartbeat and low to regular blood pressure. Two physicians have advised me to take metoprolol 25 mg twice daily. Am I at risk for a heart attack or stroke? It really concerns me. Thanks in advance. Dr. Zipes: I really need more information to be able to advise you properly. There are many causes of rapid heartbeats, and some of them are treated quite adequately with metoprolol, as you are taking. Not all of them are associated with a risk of a heart attack, but some could be. The fact that your blood pressure is normal or even a bit low (but not too low so that you have symptoms from it, I assume) is a good sign and would not be a risk factor for a subsequent heart attack or stroke. If you are concerned, an evaluation by a cardiologist (you don't indicate the specialty type of your doctor) or even an electrophysiologist (an expert in heart rhythms) could be considered.Treatment options for AF Reader: The doctors have told me that I have paroxysmal atrial fibrillation. They tell me it isn't anything life-threatening, but I can't agree. What kind of life is it for me when my heart is out of rhythm and going so fast? It leaves me very weak and nauseated. I feel like I'm just waiting for the next bad episode to come along. Dr. Zipes: Your doctors are correct in that atrial fibrillation generally is not life-threatening, but it certainly can be life-altering due to the symptoms associated with rapid heartbeats. The two most important aspects of treating atrial fibrillation are to control the heart rate and to prevent strokes. The former can be done with drugs like Toprol, which you are taking, as well as several other approaches. The latter is accomplished with the blood thinner warfarin that you are also taking.Reader: In the 1970s, I was diagnosed with heart palpitations and, later, with atrial fibrillation (AF). I currently stay in a state of atrial fibrillation, with both rate and rhythm problems. My situation seems to be deteriorating, since I am increasingly becoming more and more short of breath. I have reviewed information on the Cleveland Clinic regarding ablation procedures. I have also looked into Dr. Poa of the Enloe Clinic in California and his cardiothoracic surgical procedure on atrial fib patients. Do I appear to be a candidate for either procedure? If so, which would you recommend? Dr. Zipes: Ablation procedures to totally eliminate atrial fibrillation are still in the developmental stage but are being performed in increasing numbers at many centers. The ablation can be done by a catheter procedure or during heart surgery. The former is less invasive, naturally. The procedures can have serious side effects in a small number of patients. Success rates vary from about 65 to 90 percent, depending on the type of atrial fibrillation and the experience of the team performing the procedure.Good attitude, good results Reader: In November 1982, I underwent my first of two surgeries for bilateral intracranial aneurysm. The first surgery left me paralyzed, but after working very hard, I can now walk independently. My second aneurysm surgery took place 1/18/83. Now I have epilepsy, but it's completely controlled by my prescribed medicines. And I love my doctor. He actually cares about his patients. Dr. Zipes: I am so pleased to hear your story about how you conquered adversity to your health and how good and caring your present doctor is. A patient's attitude makes a tremendous difference in outcome from difficult medical problems, and you are a role model showing the effect that a positive, unbeatable attitude can have. Keep up your fight and, with your doctor's help, I am sure you will continue to do well.
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