Treatment may not reduce irregular heartbeat danger

I am a 72-year-old man in excellent health and physical condition. I ride a bicycle 60 miles a week, and I feel good.

I have an irregular heartbeat in the form of a premature atrial contraction, which showed up years ago for the first time on a routine electrocardiogram. I have had this for many years, and I do not have any effects from it that I am consciously aware of.

My family doctor is concerned and wants further tests. A cardiologist told me not to worry about it unless I start to have symptoms such as chest pain or dizziness.

Is it OK to just have this sort of irregular heartbeat for many years, or whether I should look into it with further testing?

Premature beats come in two different types: those that originate in the atria, the smaller upper chambers of the heart (called premature atrial contractions, or PACs); and those from the thicker, larger ventricles (PVCs). Both of these are common, and the vast majority of people with them have no problems. My training and experience correlate to what your cardiologist says.

Further, although there are medications and procedures to reduce them, there is no good evidence that the treatment will reduce your risk of an event such as a heart attack, so treatment would be purely for those few people who are noticeably symptomatic from the premature beats.

I’m a very active 79-year-old woman who had a colonoscopy three months ago and is still suffering with pain on my right side. I have had a CT scan and an ultrasound, and they say there is nothing wrong. Do you have an answer?

There are a few complications of colonoscopy that should be considered in a person with pain after the procedure. If a polyp was removed, tenderness and fever can persist for a few days.

Perforation of the colon is uncommon: It happens in 1 in 1,000 to 1 in 10,000 colon- oscopies performed for screening. Pain, fever and nausea with vomiting are the most common symptoms. These usually begin right after the colonoscopy. A rare complication is damage to the spleen (the spleen is adjacent to the colon in the left upper quadrant of the abdomen) or liver (in the right upper quadrant). The CT scan should have shown a perforation of the colon or damage to the spleen or liver.

I don’t have an answer; I have what might be charitably described as a wild guess, which is that the bacteria of the colon drastically change after colonoscopy, and that after three months you may have a different set of bacteria there. (It’s called the microbiome, and increasingly is recognized as important to many functions of the body.) If your pain isn’t too bad, I would consider a course of probiotics (healthy bacteria) to repopulate the bowel. If the pain is moderate or severe, it’s time for another visit to your doctor and possibly another evaluation.