DEAR DR. DONOHUE: I’ve been diagnosed with atrial fibrillation and would like to know more about it. I am 60, exercise regularly, have not smoked for 10 years, do not have high blood pressure, had coronary angiography showing no heart-artery blockages and have good cholesterol. What causes atrial fibrillation? What is the treatment? – B.N.

ANSWER: More than 2 million Americans have atrial fibrillation, and that number makes it one of the most common heartbeat abnormalities. “Fibrillation” means twitching. Instead of contracting with each heartbeat, the two upper heart chambers – the atria – twitch. That has two big consequences: Blood pools in the atria and can form clots that might break loose, be carried to a brain artery and block it, bringing on a stroke. The second big consequence is a very erratic heartbeat that affects the pumping of the heart’s ventricles.

Causes include a defective blood supply to the heart muscle, high blood pressure (you don’t have this), heart-valve deformities (apparently you don’t have this) and chronic lung disease (perhaps your former smoking makes you have a touch of this). Or you might be one of those in good health who just develops atrial fibrillation without a traceable cause.

Treatment is thinning blood with an anticoagulant (Coumadin) to prevent clot formation. Treatment also involves slowing the heartbeat so the heart can pump effectively. The ultimate treatment, though not always achievable, is returning the heart to a normal beat. Medicines can slow the heart rate. Some medicines can restore a normal heartbeat, but they’re not always effective.

Shocking the heart with a small jolt of electricity can reset the heart so that it beats in tempo. If fibrillation has been present for some time, this is less successful. The electrical connections between the upper and lower heart chambers can be severed and the heartbeat can then be normalized with a pacemaker. Using radio waves to zap areas in the atria that generate the abnormal rhythm is another possible treatment. That’s called ablation. Doctors can also make tiny slices in the wall of the atria to block the propagation of fibrillation signals. That’s the maze procedure. Your heart doctor has to decide which of these treatments is best suited to you.

The booklet on abnormal heartbeats deals with atrial fib and other heartbeat problems. To order a copy, write: Dr. Donohue – No. 107, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: You frequently caution your readers about the excessive use of salt. However, I’ve never read your comments regarding salt substitutes. My wife and I are in our early 70s, and we both enjoy seasoning with a salt substitute. I bet a lot of your readers would like your insight into this subject. – R.G.

ANSWER: Many salt (sodium chloride) substitutes are potassium chloride. If people have healthy kidneys and if they have no conditions where excess potassium could be an issue, then they can use potassium chloride salt substitutes.

The taste for salt is an acquired taste. If you give up salt, in about a month you’ll lose your salt craving, and you’ll wonder why you ever liked sprinkling so much of it on your food.

Other condiments – vinegar, herbs, spices – can admirably fill in for salt.

DEAR DR. DONOHUE: I have prolapse. My uterus is dragging my bladder down and pushing it out of my vagina. I can release urine only in small amounts. Is it necessary to remove the uterus to correct this? – S.G.

ANSWER: The uterus and other pelvic organs like the bladder fall down (prolapse) because supporting tissues weaken. The only definite cure for prolapse is to tighten up the support tissues surgically. Often this entails removal of the uterus, particularly in women whose childbearing days are over. Retaining the uterus can bring about another prolapse episode in the future. Removing it takes the strain off the refashioned support tissues.

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

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