Dear Dr. Roach: I have been taking warfarin (Coumadin) for two years now. I started taking it after a knee-replacement surgery, when they discovered I had A fib. I have high blood pressure and high cholesterol that are controlled with medication, and diabetes controlled with diet. Do you think I need to be on warfarin if my blood pressure and cholesterol are well-controlled?
Before the surgery, I was on two 81-mg tablets of aspirin. Could I safely go back?
J.K.
Doctors recommend warfarin or other anticoagulant medication for people with atrial fibrillation — a chaotic condition of the electrical system of the heart — if they have more than minimal risk for blood clots and stroke. Older age, female sex, high blood pressure and diabetes (even if controlled), congestive heart failure and history of stroke or vascular disease all increase risk for stroke in people with A fib. Although I don’t know how old you are, just being female and having high blood pressure and diabetes puts you in a risk category where you would normally be recommended to stay on anti-coagulation.
Never stop warfarin (or similar medication) without first discussing it with your physician.
Dear Dr. Roach: Two separate days in the past month, I woke up in the middle of the night after being asleep for about four hours and realized that my heart was beating extremely fast. I waited a few minutes and, just as I was wondering if I should go to the emergency room, my pulse started to slow down. I had no other symptoms other than my heart racing.
I am a 25-year-old female with no other health problems. My roommate said she thought it could have been caused by stress. I’m scared it will happen again. Should I go to the hospital if it does happen again? If it did happen because of anxiety, is there any way to reduce stress, other than medication or therapy?
S.C.
Waking up with your heart racing can be due to anxiety, but that isn’t a common presentation for anxiety, which usually is in response to stressful situations (or anticipating one).
Waking up with a racing heart is more likely to be due to a heart-rhythm disturbance, such as a reentrant AV nodal tachycardia. The most common reason for this is having two pathways from the top of the heart (the sinoatrial node) through the midpoint (the atrioventricular node), which then goes on to the ventricles. A circular pathway can get set up down the abnormal fast pathway and up the slow one (or vice versa) causing a very fast heart rate.
I would not wait for it to happen again but would go see a doctor and maybe get connected to a Holter monitor or event monitor. Both track your heart rhythm for extended periods of time. Once you have a diagnosis, you can be treated, with radio waves to destroy the abnormal fast pathway or with medication if it ends up being the condition I am concerned about.
Dear Dr. Roach: I am generally healthy, but my one problem is my tongue. I have a condition called geographic tongue, and it is white, patchy and with gashes. Some days it is fine and normal. Why is this happening?
A.P.
While geographic tongue, also called benign migratory glossitis, is not a rarity, it’s a complete mystery as to why it occurs. The lesions on the tongue can look like ulcers, and they come and go over hours or even minutes. Many people have exacerbations and remissions of the lesions, but they usually are asymptomatic, or may have some discomfort or burning sensation.
Geographic tongue can be misdiagnosed as a fungal infection, which can lead to ineffective and unnecessary treatment. Most people need nothing more than reassurance that it is both common and harmless.
Dr. Roach is unable to answer individual letters, but will use them in the column when possible. Send questions to ToYourGoodHealth@ med.cornell.edu.
