How can I stop my heart from fluttering?

I AM a very fit 80-year-old man and have exercised strenuously all my life. Five years ago I was assaulted in the street by a young man. I fought back and, after a long hard struggle, he ran off. Later, my heartbeat was very high and I was admitted to hospital overnight and diagnosed with atrial flutter.

Since then very occasionally when I exercise my heart rate is high and I get an atrial flutter for about three minutes. I do get anxious on the few occasions that this occurs and would be most grateful for your comments.

C. Edwards, Staines, Middx.

Aword first about the anatomy of the heart. As you are probably aware, it has four chambers. The upper chambers — the right and left atria — receive blood into the heart.

The right atrium takes the deoxygenated blood from the body, while the left atrium receives fully oxygenated blood from the lungs.

when these chambers contract, the blood goes into one of the two ventricles, which are the main power pumping chambers. The blood from the right ventricle is sent then to the lungs to be oxygenated, while the oxygenated blood from the left ventricle goes off around the body. Atrial flutter is an abnormal and fairly uncommon heart rhythm in which the atria pump at about 300 beats per minute instead of the usual 70 to 80; the ventricles also pump faster, about double the normal rate.

The main concern with this is that the upper chambers don’t empty properly, so blood is left behind and is therefore liable to clot. A clot can then travel elsewhere in the body, blocking small vessels, such as in the brain, causing stroke.

Atrial flutter may not cause symptoms, but if there are symptoms, these can include palpitations — hence the term flutter — fatigue, feeling light-headed, a sense of pressure in the chest or difficulty breathing.

Your episode was triggered, it seems, by great exertion, and probably fear. But usually atrial flutter occurs as a result of any one of a number of disorders such as an overactive thyroid, obstructive sleep apnoea (a sleep disorder that affects breathing), lung disease (such as from years of smoking), and sometimes after a heart attack; it is also linked to obesity.

This occurs when the electrical signals that control heartbeat become abnormal — similar to the more common rhythm problem atrial fibrillation, an irregular heartbeat that occurs irregularly.

Atrial flutter can be seen as a sort of halfway house to atrial fibrillation. The flutter can only be diagnosed as it is happening by an electrocardiogram (ECG — which records the heart’s electrical activity). what must then follow is further investigation into the cause.

i must assume that when the specialist examined you five years ago they didn’t find anything untoward and it was concluded that the stress of the assault was the trigger. Yet given that you appear to have brief minor episodes since, i’d suggest you need further investigations as rhythm abnormalities may become more established at some stage and persist.

At that point medication would be needed to reduce the risk of clots. such investigations would involve you wearing a small portable heart monitor for 24 hours or even seven days — the device, which is attached to two adhesive electrodes on your chest, would be carried in a pocket while you went about your normal life.

i would urge you to draw these recurrent episodes to the attention of your GP as it may be considered necessary to arrange a review by a cardiologist, even all these years on. SINCE the age of 50 I have been having the mammograms offered under the National Screening service — I’m now 56. I have been told I have dense breast tissue, and I’ve read recently that having this increases the risk of abnormalities and cancer. My doctor says I have nothing to worry about but it is still playing on my mind. Should I go for further screening?

Judy Watson, Walton-on-Thames, Surrey. how worrying for you, but it is a relief to hear you have had normal results so far. The known risk factors for breast cancer include age (the risk rises with passing years), weight (if you’re postmenopausal) and other lifestyle factors, particularly alcohol intake above about seven or ten units per week, smoking, and possibly even being sedentary and not taking exercise.

Another risk factor is the amount of time a woman has been exposed to the hormone oestrogen, from when her periods start until the menopause, which is why early periods or late menopause seem to raise the risk.

Perhaps less well known is that being tall is another risk factor (women who are 175cm or taller are 20 per cent more likely to develop breast cancer than those under 160cm), though why this might be so is unclear.

Your question is specifically about dense breast tissue, which is when there is much more ‘dense’ tissue (non-fatty tissue such as glands and connective tissues) than fatty tissue.

Most women’s breasts are made up of between 10 and 40 per cent dense tissue — with dense breast tissue, it’s up to 75 per cent non-fatty tissue. This is usually inherited, although hormone replacement therapy after the menopause may increase breast tissue.

having dense breast tissue increases the risk of breast cancer by four to five times. we don’t know why.

however, it’s important to stress that although an increase in breast density may increase your risk of being diagnosed with breast cancer, it is not associated with a greater risk of dying, and currently experts are uncertain if the screening recommendations should be changed for those with dense breast tissue.

it may be that more frequent mammography or using ultrasound scans in addition to mammograms will prove valuable, although this is yet to be shown.

BUT the most important factor, as so often in medicine, is a high index of suspicion — which means looking very carefully at the mammography pictures of those with dense tissue and having a low threshold for deciding to take a biopsy if there is the least doubt.

Multiple studies over the past four decades have confirmed that mammography for women aged 50 to 70 reduces the risk of breast cancer death.

My advice to you is to continue on the recommended programme, never smoke, minimise your alcohol intake, and take regular physical exercise. we also know that a diet composed mainly of fruits and vegetables is protective.