Your questions answered


Can you substitute Aspirin for Warfarin? Does taking your cholesterol medication at different times of day make a difference? Should you be taking vitamin supplements even if you’re in good health? These and other questions answered here…

I am on Warfarin for my irregular pulse. Can I switch to Aspirin instead?

No. Atrial Fibrillation (AF) is often related to other heart problems, age and smoking. The irregular pulse leads to sluggish flow of blood in the atria(upper heart chambers), causing clots to form inside the heart. A piece of this clot can enter the circulation where it eventually reaches an artery small enough to trap it: this blocks the artery, preventing any further blood flow. A clot from the right heart chambers can lodge in the arteries to the lung, causing a (possibly) fatal pulmonary embolus. A clot from the left heart chamber can lodge anywhere in the body, but nearly always goes to the brain, causing a stroke. It may also go to the heart, causing a heart attack.

Your body makes clots in two ways. One system uses clotting factors made in the liver: this system can lead to clots in the heart in AF. Warfarin acts by inhibiting these clotting factors thereby preventing clots forming in the heart and protecting you against emboli and strokes.
Aspirin inactivates the other clotting system, which uses tiny blood cells called platelets, which clump together at the site of tissue damage, forming a temporary “plug”, until another mechanism is activated, forming a permanent seal. As this is not the way clots are formed in the heart in AF, paralyzing platelets with aspirin will have no protective benefit for patients with AF.


I am 32, have Type II diabetes, and take Glucophage 1 tab twice daily. My heart has been beating abnormally fast during the last two days. How serious is this? I don’t want to have a heart attack...

A diabetic has an increased risk for heart problems, compared to a non-diabetic.However, a far more likely cause for your fast pulse is an infection somewhere: you have to rule out this possibility first, as your diabetes renders you very susceptible to infections. Skin, urinary tract and respiratory tract are common sites.

Please see your doctor as soon as possible. Undiagnosed and untreated infections will make your blood sugar go out of control, further compromising you. If there is no obvious infection and your symptoms persist, then consider a blood test for thyroid function. If that is normal, and your pulse is still fast, then you would be wise to see a cardiologist for a full assessment.

Is there any particular time of day one should take Cholesterol medication. I have been told by a colleague that you should take it at night as cholesterol is formed at night. Is this true?

Most manufacturers recommend that the medication be taken at night. The liver enzymes which convert dietary fat into cholesterol do seem more active night, so taking your dose in the evening will provide maximum effect. Also, should any unpleasant side effects occur, like mild nausea or muscle aches, they will happen during sleep, and thus be less disturbing.

Is it essential to take vitamins and supplements even if you are in good health?

Vitamins are essential substances needed in small amounts, but not manufactured by the body. They must therefore be obtained from food, and following a balanced diet should provide all the necessary vitamins. However, for various reasons, many people cannot or do not have a balanced diet, and vitamin supplements can play an important role here. A popular but unproven theory claims that modern harvesting, processing and cooking techniques destroy most of the vitamins in food, making it necessary to take vitamin supplements.

Unlike water-soluble vitamins, the fat-soluble vitamins A, D, E and K can be stored in the body, and these can accumulate to toxic levels. If you use vitamin supplements, the safest option is a daily dose of a multivitamin: this will contain all the vitamins you need, in the correct proportions. Studies show that this allows the vitamins to work together at their best, and will prevent accidental overdosing, which can so easily happen when different vitamin preparations are used together.

I am a 50-year-old woman, and often have a fluttering feeling in my chest. I am a smoker and have high blood pressure. Should I be worried?

Your age, smoking and high BP put you at high risk for heart disease. Remember that women’s symptoms of heart disease are often vague – such as fatigue, unusual shortness of breath, nausea and an “uneasy” feeling in the chest. Heart disease is a leading cause of death amongst women, but if diagnosed early and correctly treated, the outlook is good. Please consult a cardiologist for a full diagnostic workup. He will advise you how to stop smoking, attend to any other risk factors you may have and start a moderate exercise program if you are not already on one.

How important is exercise after surgery and what are the disadvantages of not doing any after a four-artery bypass?

Lack of regular moderate exercise contributes towards heart disease. As you have already needed bypass surgery, you will need to change your lifestyle to prevent the disease progressing. Exercise is not the only factor, and if you do not change other factors in your lifestyle, you will simply land up where you were before: your new bypass grafts will develop the same disease your original arteries had.

Plus, the other heart arteries which are at present still healthy will also become diseased, and you may need another bypass operation. Remember, that the exercise should be moderate, but regular. For advice regarding specific exercises, and when to start them, please consult your surgeon, who can refer you to your local cardiac rehabilitation services.

However, it is far more important to change your whole lifestyle to include sensible eating, weight loss, no smoking, and control of hypertension. These are factors which directly affect your heart arteries, and including moderate exercise in this lifestyle will add even more benefit.