HEALTH MATTERS: Your health questions answered

Q. I’m an otherwise healthy 75-year-old woman. I recently noticed an irregular pulse and my doctor diagnosed “atrial fibrillation.” What is it, and should I be worried?

A. Atrial fibrillation is a relatively common problem that is seen especially as people age. It affects about one in 100 of us overall, but its incidence increases to about 10 percent in elderly senior citizens.

It occurs when the top chambers of the heart (the atria) develop short circuits, and irregular, rather than rhythmic, beating occurs. The most important factor that affects how well you do is whether the atrial fibrillation occurs alone, or whether it is associated with other conditions such as a leaky valve or high blood pressure.

Atrial fibrillation causes two basic types of problems: First, the irregular heartbeat itself causes symptoms in many people, especially since the irregular rhythm is often fast as well; and second, the irregular beating of the atria can lead to the formation of blood clots within the atria. If these clots break loose from the heart, they can travel to the brain and other organs and cause major complications, such as a stroke or even death.

Treatment consists of three different strategies:

• 1) Control the irregular, and often fast, rhythm with medication.

• 2) Convert the irregular rhythm back to regular rhythm with medicine, an electrical shock, or a procedure known as “ablation,” or more formally as “pulmonary vein isolation.”

• 3) In many cases, use medication to prevent clots from forming. The medicine to prevent clots may be aspirin, or a blood thinner called warfarin. Which of these approaches is best for you depends on many factors, especially whether you have any other heart problems or other conditions such as a valve problem, high blood pressure, or heart disease. But most patients tolerate atrial fibrillation just fine, often for years and years.

Q. I’ve been feeling tired and have gained some weight. My nurse practitioner did a blood test and put me on medication for an underactive thyroid gland. Please educate me about this condition.

A. The thyroid gland is located around the windpipe (trachea) at the base of the throat. It secretes several hormones that regulate the metabolic activity of the body—too much leads to overactivity (called hyperthyroidism) and too little to underactivity (hypothyroidism).

You have an underactive thyroid gland that is not secreting enough of the hormones that you need, so you feel sluggish, tired and have gained weight.

Treatment is straightforward in most cases; just give more thyroid hormone by mouth in the form of pills. Because the activity of the thyroid gland is actually controlled by the brain, we diagnose the activity of the thyroid gland by measuring the messenger compound that the brain sends to the thyroid to regulate its activity, called TSH or thyroid stimulating hormone.

The TSH level is increased with an underactive thyroid (since the brain tries harder and harder to increase thyroid activity, and thus secretes extra TSH), and is low when the gland is overactive. Your nurse practitioner will adjust your thyroid dose by making sure that the TSH level is just right for you. You’ll be feeling better soon.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

Tags: atrial fibrillation, life, health