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Medical Edge Newspaper Column from Mayo Clinic

TREATING ATRIAL FIBRILLATION: SLOW HEART, RESTORE NORMAL RHYTHM

DEAR MAYO CLINIC: I have atrial fibrillation and was changed from aspirin to warfarin. I get winded when doing steps and bending. What can you recommend for me to improve my ability to do physical activities? — St. Cloud, Minn.

ANSWER: Atrial fibrillation is the medical term for a heart that beats out of sync. The heart’s two upper chambers beat chaotically and out of rhythm with the heart’s lower chambers. The condition generally isn’t life threatening, but it can cause shortness of breath, a racing heart sensation and other symptoms. Atrial fibrillation increases the risk of stroke and congestive heart failure.

Warfarin (brand name Coumadin), a blood thinner, helps reduce the risk of stroke associated with atrial fibrillation. Many studies have shown that it’s more effective than aspirin, which is probably why your doctor recommended the change.

You have other treatment options that could make it easier for you to be active. The treatment goals are to slow the heart rate and to restore normal rhythm.

Medications to slow the heart: Ideally, your at-rest heart rate should be 60 to 90 beats per minute, and 120 beats per minute when you’re active. If you’re above these levels, your doctor could recommend medications to help slow the heart. Options include digoxin (Lanoxin), calcium channel blockers or beta-blockers.

Restoring normal rhythm: Electrical cardioversion is a procedure to shock the heart back into normal rhythm. About 95 percent of the time, the heart will return to normal rhythm. Several medications can help maintain normal rhythm. Some have significant side effects and require close monitoring by your doctor. Long term, about 50 percent of patients stay in normal rhythm with medication.

If cardioversion fails to keep the heart in sync and symptoms return, you can consider other procedures such as catheter ablation. An electrophysiologist places several catheters in the chambers of the heart to locate and ablate (burn) hot spots where the pulmonary veins join the left atrium. These ablations stop the electrical short circuits that cause the irregular rhythm. The procedure is performed at major medical centers.

Bottom line: Continue warfarin and talk with your doctor about options to restore normal heart rhythm and better control your heart rate.

— Stephen Hammill, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Additional Resources:
Information on Atrial Fibrillation
Appointment Information
More Information on Atrial Fibrillation

READERS: If style is the main objective when you select shoes, your feet may suffer, especially as you age.
Over time, your feet become wider and longer and the natural padding under your heel and forefoot thins. Years of use also flatten your arches and stiffen your feet and ankles.

If you often wear shoes that are too short or too narrow, you may develop foot deformities such as bunions, calluses or corns, hammertoes, or pinched nerves between your toes. Wearing better-fitting shoes reduces your chances of developing deformities or making them worse.

Here are some tips for selecting shoes:

— Try on shoes later in the day. Feet can swell as the day wears on.

— Fit shoes to your largest foot. Your feet aren’t equally matched, so have both measured.

— Make sure there’s at least a half-inch for your longest toe at the end of each shoe when you’re standing. You should be able to wiggle all toes.

— Make sure your heel doesn’t ride up and down when you walk.

— Leave too-tight shoes behind. There’s no such thing as a break-in period.

— Look for shoes that are solidly constructed, conform to your feet and have cushioned soles that absorb the shock of hard surfaces.

— Try a lace-up style. A shoe that ties can be adjusted for better comfort and support.

— Look for a natural material, such as leather, on the upper portion of the shoes, because it’s usually softer and provides more flexibility than a manmade material.

If you have diabetes, osteoporosis, rheumatoid arthritis or other conditions that put you at risk of foot problems, ask your doctor if any other precautions are recommended.

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.