Do I HAVE to take pills for my dicky heart?

IS THERE an alternative lifestyle regimen instead of the recognised medication route for atrial fibrillation?

Brian Thake, by email.

ATRIAL fibrillation, the most common heart rhythm abnormality, is where a patient’s heartbeat becomes ‘irregularly irregular’.

Essentially the rhythm is all over the place, completely random, due to a malfunction in the heart’s natural pacemaker.

When the heart beats normally, its walls contract to force blood out and around the body. they then relax, so the heart can fill with blood again.

in atrial fibrillation, the walls of the atria — the upper chambers of the heart — no longer contract as normal, but quiver or squirm.

this means they do not empty blood fully and efficiently into the two ventricles (the heart’s main pumping chambers), and some may be left in the atria. as a result, the heart pushes out a smaller volume of blood with each beat.

Many patients have no symptoms and the condition often goes unnoticed. Others may have mild symptoms such as palpitations (irregular thumping or fluttering sensations in the chest), tiredness, or shortness of breath after minimal exertion.

Meanwhile, some people will suddenly become severely breathless, along with feeling dizzy or faint.

atrial fibrillation can be either intermittent — in bouts lasting minutes, hours or even days — or it may occur all the time.

EITHERway a complication of the condition is that it puts patients at increased risk of stroke. this is because blood can pool and clot in the atria, and if the clot gets pumped into the circulation, it may block arteries in the brain.

For this reason it’s important to adhere to the best possible established treatment regimen.

the strategy that cardiologists follow depends on the patient’s history and the cause of the problem (common causes include binge drinking and damage to the heart following a heart attack).

Some patients are offered cardioversion, where doctors attempt to reset the heartbeat with an electric shock; or catheter ablation, where we thread a tube into the heart and then deliberately damage the areas that are triggering the faulty rhythm (with radio frequency, for example).

treatment also involves medication — in the form of anticoagulants that help prevent blood clots — which should be started promptly to minimise the chances of a stroke. traditionally we prescribe warfarin, although this calls for frequent blood tests to make sure patients are getting the correct dose.

in the past few years a group of drugs called novel anticoagulants have come into use. these drugs, such as dabigatran, apixaban, rivaroxaban, work just as well as warfarin and are equally safe, but with no need for regular blood tests. Some patients may also be prescribed drugs to control heart rate or rhythm.

Unfortunately, once atrial fibrillation has become established, there are no lifestyle changes, in terms of diet, exercise, or complementary medicines, proven to help stop it. and, given the risk of stroke, it would be unwise — even dangerous — to avoid conventional anticoagulant measures.

however, any lifestyle changes that may benefit the heart must be adopted. these include avoiding smoking, minimising alcohol intake, taking moderate daily exercise (if your symptoms allow), controlling excess weight and minimising salt in the diet.

it’s important to undergo any relevant investigations to be sure any underlying cause has been detected and, where possible, treated, though that may not put the clock back once the abnormal rhythm has developed.

FOLLOWING a visit to a neurologist, I have recently been told I have parkinsonism and have been put on a low dose of Sinemet. I asked my doctor the difference between Parkinson’s and parkinsonism, but have been told it’s a ‘play on words’. What is your view? I can walk, on average, three miles.

Name and address supplied. it is easy to get confused with technical terms in medicine.

to clarify this for you, parkinsonism is a term used to describe a group of features which include tremor, slowness of movement (known as bradykinesia), rigidity of muscles and balance problems. a collection of symptoms such as this is what’s known as a clinical syndrome — it is not a diagnosis.

there are many possible causes of parkinsonism. these include exposure to some toxic substances (such as carbon monoxide and mercury), conditions such as Wilson’s disease (an inherited disorder in which copper builds up in the body) and medicines including metoclopramide, used for nausea and vomiting, and certain anti-psychotics.

Essentially, these interfere with the production of critical chemicals in parts of the brain essential to controlling movement.

But the most common cause is Parkinson’s disease — a disorder of the nervous system which affects 1 per cent of people over 60. in this condition, nerve cells in a part of the brain called the substantia nigra degenerate, losing their ability to produce the chemical dopamine, which plays a vital role in regulating movement. We don’t know the exact cause, but there may be a family tendency.

FROMwhat you tell me it appears your diagnosis is Parkinson’s disease. there are no definitive tests for it. Diagnosis is based on the patient’s history, symptoms and the way they have developed.

in Parkinson’s, the most obvious symptom is the tremor, and it typically starts on one side of the body and spreads to the other side over months or years. and bradykinesia and muscle stiffness may gradually make activities such as walking difficult.

You have been prescribed levodopa, in the form of Sinemet — a drug that replaces the lost dopamine. i can assure you that this is the most effective drug for the relief of the symptoms. it is particularly helpful at improving the bradykinesia, though it will also ease the tremor and rigidity.

in your longer letter, you say you are under the supervision of a specialist nurse, who will help you in terms of what to expect, how to manage symptoms and how to take medication correctly.

it seems this is working well for you.