Tulsa World: Cardiologist, not general practitioner, should treat atrial fibrillation

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Cardiologist, not general practitioner, should treat atrial fibrillation

By PETER GOTT, M.D. Newspaper Enterprise Association
Published: 7/17/2009 2:21 AM
Last Modified: 7/17/2009 5:19 AM

Dear Dr. Gott: I was recently diagnosed with atrial fibrillation. My family practitioner sent me to a cardiologist at my request for a second opinion.

My GP suggested I start warfarin and have an angiogram. The cardiologist says, "A-fib isn't something that calls for an angiogram" and put me on warfarin and diltiazem. He is now telling me that I can do one of two things: have a transesophageal echocardiography followed by cardioversion (his preference), or I can stay on the medication for the rest of my life.

I have no symptoms except for a fast pulse and some shortness of breath upon exertion. I am a 78-year-old retired nurse. I have no physical problems other than osteoarthritis. I also take losartan for high blood pressure, which is now stable at 120/80.

What is you opinion on how I should proceed?

Dear Reader: Atrial fibrillation is a heart disorder that causes an abnormally rapid, irregular heart rate; therefore, I believe your cardiologist is the best choice for treatment.

Symptoms may not be noticeable in some sufferers but may include decreased blood pressure, chest pain, shortness of breath, weakness, lightheadedness, confusion, fatigue, fainting and palpitations. If symptoms come and go, the condition is known as paroxysmal atrial fibrillation, whereas consistent symptoms denote chronic a-fib.

The risk of developing this condition increases with age. Heart failure, coronary-artery disease, high blood pressure, heart attack, certain medications,

heart-valve defects, hyperthyroidism, heart surgery and infections (especially of the heart) are common causes. In some cases, no cause can be found. This is known as lone atrial fibrillation, and serious complications are rare.

Follow your cardiologist's advice or seek out a second opinion from another cardiologist.

Write Dr. Gott c/o United Media, 200 Madison Ave. 4th floor, New York, NY 10016. By PETER GOTT, M.D. Newspaper Enterprise Association

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	Report Comment tao4mind, Enid (7/17/2009 11:05:13 PM) At 78 years old, first thought is a decrease in the production of red blood cells, B12 vitamins. The artical fails to mention race, sickle cell disease, weight, an overactive thyroid gland. Many things can cause rapid pulse and feeling weak and tired. Your a nurse, look for the obvious, is there any yellowish look to your skin and the whites of your eyes, jaundice. Shortness of breath means getting high blood pressure in the lungs. Any pain in the hands, the feet, are not mentioned. Could be an iron deficiency, folic acid deficiency. This losartan you take for high blood presure is an Angiotensin II receptor blocker that inhibit a substance that causes blood vessels to narrow. As a result, blood vessels relax and widen, making it easier for blood to flow through the vessels, which reduces blood pressure. This medicine can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use losartan. I will have to agree with DR. Pete, seek a cardiologist's advice and get off losartan under that doctors care. When a woman gets to age 78 she should have a personal massaging pool boy to rub her neck to relieve an overactive thyroid gland before the visit to the cardiologist.
	Report Comment upinarms, (7/18/2009 6:05:25 PM) I wonder if the personal massaging pool boy could be justified by other ailments, not just an overactive thyroid gland. Am not 78 yet, and my thyroid is more on the underactive side, and yet...a PMPB sounds very appealing. I wonder would insurance cover that? For men, would a PMPG be the equivalent?
	Report Comment Bedazzled, (7/19/2009 12:07:14 AM) His doctor should have told him to follow the Cardiologist's instructions. This is something my mother had too and it can be serious.
	Report Comment Daniel Day Simpson, Edmond (7/17/2009 9:41:23 AM) Check a university health program for solutions. You may get a procedure done at significant savings if not free. This is something a medical school would love to delve into.

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