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DEAR DR. ROACH: You recently used the term “abnormal irregular heartbeat.” I’ve had an irregular heartbeat for decades without seemingly ill effects. My doctors haven’t put any restrictions on my vigorous cycling or any other activities that I do at 84 years old. Does this mean that I have normal irregular heartbeats? Is there an implied difference by your use of “abnormal”? -- S.B.
ANSWER: The answer is more complicated than it might seem. A perfectly regular heartbeat is, perhaps counterintuitively, not normal. The heart should respond to subtle changes in chest pressure due to breathing -- a condition that’s called sinus arrhythmia. Although it sounds bad, it’s a sign of a healthy heart. People with lower-than-average variability in their heart rate -- such as people who’ve recently had a heart attack or those who’ve had heart failure -- often have an increased risk of bad outcomes.
There are other common irregular heartbeats, especially premature atrial contractions and premature ventricular contractions. An average person without heart problems may have hundreds of these per day. The majority of people have at least a few of these a day, so I’d call these “normal irregular heartbeats.” However, some people have thousands of these daily, which can be enough to cause symptoms, so they aren’t always entirely benign.
By contrast, there are a wide variety of abnormal irregular heartbeats. In the recent column that you’re referring to, the issue was specifically atrial fibrillation -- a common rhythm disturbance that can cause heart symptoms and strongly predisposes people to blood clots, which can cause strokes.
Other rhythm disturbances can be immediately fatal (ventricular fibrillation), rapidly life-threatening (ventricular tachycardia), or symptomatic and potentially dangerous (paroxysmal atrial reentrant tachycardia). An entire branch of cardiology (electrophysiology) is devoted to the study and treatment of rhythm disorders.
I don’t know enough about you to be sure what you have, but the fact that you have excellent exercise tolerance at 84 and your doctors don’t have any apparent concerns suggest that severe abnormalities are very unlikely.
DEAR DR. ROACH: I read a recent news report suggesting that an old drug, lacosamide, could reverse and repair cartilage damage in people with osteoarthritis. What are your thoughts? -- P.C.
ANSWER: I read the paper from July about the potential for the anti-seizure drug lacosamide to help relieve pain and protect cartilage from damage. The study was done in mice, initially by injecting the drug directly into the joint, then by encapsulating the drug into a hydrogel that released the drug slowly over weeks.
This is promising, but it’s a long way before this could be tested in humans. Additionally, the need to inject it directly into the joint would limit its use to people with mostly large joints. Headline writers know that sensational statements generate more readers, but in my opinion, it’s a long way to go to reach success in clinical trials.
Most promising treatments fail along the way. However, this doesn’t stop me from being hopeful because better treatments to slow osteoarthritis are needed, as most older adults do experience symptomatic osteoarthritis.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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