DEAR DR. DONOHUE: You frequently use the term “blood thinner” when I think you should be using the correct term, “anticoagulant.” I think I know the reason why you use the former term, but I also think that, in the interest of accuracy, you should hew the line. – R.W.

I do say “blood thinner” when I should say “anticoagulant.” I do so because “blood thinner” has become a standard substitute for “anticoagulant” for most people. I am now considering whether I should hew the line. (I like that expression.)

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475

DEAR DR. DONOHUE: I have had chest pains, and my doctor is not sure if they come from a block of the circulation to the heart muscle. He wants me to take a stress test. I have no objections, but I have bad arthritis and cannot run on a treadmill. He tells me there are ways of getting around such a problem. What are they? – M.L.

ANSWER: When a person exercises, the heart muscle requires more blood. A stress test is an exercise test during which the patient is continuously monitored with an ECG. The most common way to “stress” a person is to have that person run on a treadmill whose speed and incline increase every three minutes.

If there is a block of blood flow in one or many heart arteries, the lack of flow creates changes in the ECG that are readily spotted.

People like you have a disability that makes it impossible for them to run on a treadmill. These people can have a so-called pharmacological stress test. “Pharmacological” indicates that a drug is used to stress the heart.

Dobutamine is a drug that can get the heart beating as fast as exercise can. It is one of the pharmacological stress-testers. Dipyridamole and adenosine dilate healthy heart arteries. If a heart artery is partially blocked, the medicines fail to dilate such an artery, and blood is shunted away from that artery. A radioactive tracer clearly demonstrates blood bypassing the blocked artery.

There is yet another step that can be taken when people are unable to perform a stress test or when they cannot tolerate a pharmacological stress test. That procedure, an angiogram, consists of injecting dye directly into heart arteries and then taking pictures of the arteries with X-rays.

DEAR DR. DONOHUE: I am confused, and I am also 86. I have an irregular heartbeat. It goes beat, beat, beat, stops, then there is a thud, and then the beat, beat, beat pattern resumes.

My doctor tells me I also have a leaky heart valve. He offered me no medicines. Shouldn’t I take medicines or have a pacemaker or have my valve repaired? Won’t doctors operate on people who are 86? – T.W.

ANSWER: Your description of your heartbeat rhythm fits the tempo of a beat that has premature contractions – beats that come before they should. Those beats are premature ventricular contractions. They are extra beats that originate in the lower heart chambers, the ventricles. Normal beats originate in the upper heart chambers.

People do not feel the premature beat. In fact, it feels like a temporary pause in the heart’s rhythm. Because it comes early, there is less blood in the heart, and the beat is often too feeble to be felt – your “stop.”

The beat after the premature beat is the thud you feel. On that beat, the heart has more than its normal volume of blood, and when the heart contracts, people feel a thud in their chests.

Premature beats are often ignored. Treatment can create more problems than it solves. Unless they are producing a heart malfunction, doctors often ignore them. You do not need a pacemaker.

Leaky heart valves need attention only if the leak is so great that it’s upsetting the normal flow of blood from the heart.

Your doctor is a man of few words. Don’t let him be. On your next visit, be sure to ask him if you have premature ventricular beats and if your heart valve leak requires attention. Eight-six does not disqualify you from having heart surgery.

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