Features

Ask dr. h

October 27, 2009

An irregular heartbeat needs standard treatment Ask dr. h Mitchell hecht

Q: I am a 77-year-old female who has been taking Coumadin blood thinner for an irregular heartbeat (atrial fibrillation) for the past five years. It has been suggested by a trusted relative that I discontinue the Coumadin and take minerals, niacin, potassium and magnesium. Do you agree or disagree?

A: I emphatically disagree with the well-intentioned, but bad advice from your relative. Let me explain why: In atrial fibrillation, the electrical impulses that trigger synchronized contractions of the upper and lower chambers become disorganized, such that the atria contract rapidly and ineffectively. Instead of blood moving smoothly into the ventricles, it tends to slosh around in the right and left atria, looking like a bag of worms.

Sometimes that causes a rapid heart rate with symptoms of dizziness, palpitations and weakness.

Regardless of whether or not the person has symptoms, it needs to be dealt with. The sloshing around of blood greatly increases the risk that a clot will form.

If a clot is pumped out of the heart and becomes lodged in an artery of the brain, a stroke will result.

The clear consensus opinion from numerous trials looking at long-term anticoagulation to prevent stroke is that Coumadin — not aspirin, Plavix nor any of those advised supplements — is able to show a dramatic reduction in the risk of stroke from atrial fibrillation.

Q: Three months ago, I had a breast biopsy that fortunately turned out to be benign (not cancer), but now I’m left with a scar that I’m not happy about. I’m wondering why the surgeon didn’t just do a needle biopsy. Can you tell me why?

A: I cannot comment on your specific breast mass, but there are very few instances where an open surgical biopsy would be needed as the initial diagnostic procedure. In fact, a panel of leading breast surgeons at the 2009 International Consensus Conference on Image Detected Breast Cancer III unanimously agreed that needle biopsy should be the “gold standard” for the initial diagnosis of breast abnormalities.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Atlanta, GA 30076. Due to the large volume of mail received, personal replies are not possible. — M.B., West Chester, Pa. — S.R., Sarasota, Fla.

Tweet	Follow @TLnews