DEAR DR. DONOHUE: What are people with atrial fibrillation to do when they can’t take medicines and can’t take anticoagulants because of a history of stomach bleeding? We fear a stroke if something isn’t done for this person.

Are other antiarrhythmics worth a try? – B.S.

ANSWER: Not all readers appreciate the dilemma this person faces. With atrial fibrillation, one of the most common heartbeat abnormalities, the atria – the upper heart chambers – are not beating normally. They’re squirming at a fast rate. That generates an erratic, fast heartbeat that decreases the heart’s pumping efficiency. More dangerously, it fosters the development of clots in the atria. Pieces of those clots can travel in the circulation to the brain and obstruct a brain artery. The result is a stroke. That’s why people with atrial fibrillation are placed on anticoagulants – blood thinners.

There are 10 antifibrillation drugs. How many has this person tried? That might be the answer to the problem.

Has this person’s doctor tried giving the heart an electric shock? It’s true that long-standing atrial fibrillation doesn’t respond to a shock as readily as new-onset fibrillation does, but if the doctor believes it’s worth a try, then it’s another possible answer.

There are many surgical procedures that can convert atrial fibrillation into a normal heart rhythm. One is the maze procedure. Multiple tiny incisions are made in the atria. They serve as gates that block the propagation of the abnormal electrical impulses that are responsible for the chaotic heartbeats. Your acquaintance should talk with a cardiac electrophysiologist, a heart specialist who is an expert in regulating heartbeats.

The maze procedure is only one technique. There are others. If a regular heart rhythm is restored, then the need for an anticoagulant goes away.

DEAR DR. DONOHUE: Please explain what happens when a person puts a nitroglycerin tablet under the tongue. – L.D.

ANSWER: Nitroglycerin is a medicine for angina, the chest pain that comes on when the heart muscle isn’t getting enough blood.

Nitroglycerin dilates blood vessels. That helps the heart in two ways. By dilating veins, blood stays in them a bit longer, and slightly less gets back to the heart. The heart doesn’t have to pump such a large volume of blood with each beat. It gets a rest.

Nitroglycerin also dilates heart arteries. More blood gets to the heart muscle. That eases angina pain.

Putting nitroglycerin under the tongue makes for faster absorption. The results from taking it this way are seen more quickly than they are from a swallowed tablet.

Nitroglycerin also comes in a pump that sprays it onto or under the tongue – another way for it to get into action fast.

DEAR DR. DONOHUE: I was interested in what you last wrote about hammertoe. I have one on each foot. I was hoping to get some hints about dealing with them. I would appreciate any tips you can provide. – M.L.

ANSWER: A hammertoe is one whose first joint (knuckle) is bent upward so the tip of the toe bends down. The toe looks like an upside-down V.

The first knuckle rubs against the shoe, and a painful callus forms. The same happens to the tip of the toe, which rubs against the shoe’s sole.

If the joint changes are not solidly fixed, stretching the joints can help realign them. Straightening the toe and taping it to the adjacent toes can lessen the bend.

However, for most, the joint is rigidly bent, and the only correction that will help is surgical.

People can always pad the upward-bent knuckle and the downward-bent toe tip, but they must have big-enough shoes to accommodate the padding.

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. Readers may also order health newsletters from www.rbmamall.com.