Published April 5, 2007 in issue 0614 of the HooK.

By JOHN HONG, MD [email protected]

Grey's Anatomy, ER, and Scrubs are popular shows, but I'd rather watch C-SPAN covering a filibuster. I can't watch a show that's germane to the medical field because my mind races to make the diagnosis before the people on the show do-- which is impossible to do since they never make a real diagnosis.

Moreover, I hate that they always get things wrong. Not a little wrong-- majorly wrong! Hello! Somebody throw a Merck Medical Manual to the writers. My friend did a residency with a woman who hated to work fast. She tra-la-la'd her way to emergencies slower than Carmen Electra falling on her keester on the runway. Because she couldn't get a job, she ended up in Hollywood as a medical consultant. That's why I see stupid mistakes on TV like chest x-rays backwards, stethoscopes on backwards, gowns on backwards-- hmmm, sounds like one of our congressmen.

Medicine is a hard thing to grasp-- for example: the heart is not shaped like the I Love Lucy heart. It consists of four chambers: the two top ones are the atria, and two lower ones are ventricles. But I guess Cupid wouldn't be so cute shooting his arrow into a thing that looks like a over-ripe persimmon. 

Atrial fibrillation (aka "A-fib") is an arrhythmia that makes the heart beat very irregularly. So when you hear that your dad or mom has an irregular heartbeat, it's probably A-fib. The right atrium is the Timex Watch of the heart-- sending out impulses to make the whole heart beat in a timely manner. But if the atria get stretched or diseased, the timing can be permanently messed up (like a lot of the dancing seen at weddings). 

About two million Americans have A-fib, and the prevalence is only going to get higher because it tends to afflict the elderly. Hypertension, heart disease, and alcoholism can put one at risk for chronic A-fib. A large percentage of people don't even know they have A-fib until they see the doctor who says, "Girl, you know that song, ‘I got rhythm, I got music...'? Well, your heart doesn't." 

Palpitations (feeling your heart pound) is usually what bothers people with A-fib. If the heart beats too fast, the heart might not pump effectively, leading to shortness of breath, lightheadedness, fatigue, and even chest pains. In A-fib, the heart can beat easily over 150-- and no, that doesn't count as aerobic exercise. In fact, A-fib can throw someone into congestive heart failure.

The biggest threat of A-fib is a stroke. Because the atria don't really pump well, blood can sit there and form clots. If a clot forms and is pumped out, it can block a brain artery. So anticoagulation is normally done to thin the blood-- preventing clots in the atria. The downer about anticoagulation is that it can make "sticks and stones" worse than breaking your bones in those who fall down easily, like Carrie Bradshaw when she was fashion roadkill on the runway in Sex & The City.

Anti-arrhythmics (not to be confused with the '80s group with Annie Lennox) are used to keep the heartbeat regular, but unfortunately they are pretty toxic. So rate control is becoming more of the goal today– to keep the heart from racing too fast. And of course, there are interventions that can "cure" A-fib in some folks.

If I were a Hollywood consultant, I think I would distort medicine as much as possible just to see how much I could get away with. Do you think viewers would believe that A-fib is a lie? And a-men is not a term used in church but to describe men who have Personality A trait? A-dios!

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