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Living with Atrial Fibrillation
Kevin Wheelan, MD discusses heart rhythm disorders and living with atrial fibrillation.
Featured Speaker:
Kevin Wheelan, MD, FACC
Kevin R. Wheelan, MD is board certified in Internal Medicine, Cardiovascular Disease and specializes in cardiac electrophysiology. Dr. Wheelan's professional interests include catheter ablation for complex arrhythmias, pacemaker and defibrillator therapy including bi-ventricular resynchronization therapy for the treatment of heart failure. He is actively involved in advanced clinical research trials. His work has been published in leading peer-reviewed journals and he has frequently been invited to present his findings at the top national and international conferences and educational events. He is currently on the medical staff at Baylor Scott & White Heart and Vascular Hospital - Dallas and Baylor University Medical Center at Dallas. Transcription:
Living with Atrial Fibrillation
Prakash Chandran (Host): Have you ever felt like you heart was fluttering or pounding against your chest? If your heart races and even skips a beat and the feeling lasts for a few minutes; you could have a condition called atrial fibrillation. Let’s talk about it today with Dr. Kevin Wheelan, the Chief Medical Officer at Baylor Scott & White Heart and Vascular Hospital in Dallas. This is HeartSpeak, the podcast from Baylor Scott & White Heart and Vascular Hospital – in Dallas and in Fort Worth. I’m Prakash Chandran. So, Dr. Wheelan, let’s start with the basics around learning a little bit more about what atrial fibrillation or AFib is.
Kevin Wheelan, MD, FACC (Guest): Well Prakash, let’s start out with how the heart works normally. Heart is a mechanical pump that has an electrical control system very much like the spark plugs in your automotive engine. The timing of that is coordinated by a region called the sinus node, which is the normal timeclock that regulates your heart, helps slow it down when you go to sleep at night, helps it speed up when you need to do your normal daily activities or when you start doing more aggressive physical sports, running, jogging, et cetera.
That electrical system is complicated in that it coordinates the top and bottom half, right and left side of your heart and keeps the valves opening and closing as efficiently as possible. Atrial fibrillation is a short circuit in the control mechanism in the top part of the heart causing it to be very, very erratic and frequently very rapid. And much like if you were driving your car on the ice and your wheels started spinning, speedometer is going fast, you are just not moving; the heart is not pumping effectively when it goes into atrial fibrillation.
Host: I’m wondering, I feel like I have experienced some of this before when I’m working out really hard, but I’m curious to how someone might know that they have atrial fibrillation and is it common?
Dr. Wheelan: It’s a common electrical problem that occurs in up to 10% of the population by the time they are in their 80s. We tend to see it begin in the 40s, 50s and increasingly after that and there are different risk factors associated with AFib. Probably the most important thing you hit on is if an individual feels like their heart is skipping, racing, very fluttery sensation in their chest; that might be the manifestations of atrial fib that they would be aware of in terms of feeling this sensation of irregular, rapid beating. It could also be associated with difficulty breathing, doing normal activities that you would normally be able to do without any trouble, all of the sudden become much more difficult to do.
There can be lightheadedness, shortness of breath, and in some individuals, there can be chest discomfort associated with it because if the heart is beating overly rapidly; it’s taxing itself and it can manifest in many different ways in individual patients depending on other conditions that they may have.
Host: Okay and what are the risks or dangers associated with atrial fibrillation? Is it just something that the individual has to deal with, or can it lead to other more serious things?
Dr. Wheelan: There are three things that are associated with atrial fib. One, having atrial fibrillation is associated with a slightly reduced life expectancy. That’s very complicated and may be due to other cardiovascular problems that a person has, and atrial fib is one of those manifestations. More commonly, atrial fib divides itself into two categories. It increases one’s risk of having a stroke which is a blood clot that breaks loose and goes to the brain and causes an impairment of brain function. More commonly, atrial fib manifests in an alteration in the efficiency of the heart to do it’s job. So, people experience the symptoms we’ve talked about, uncomfortable sensation of something just not feeling right in their chest, their heart is fluttering or racing at a time when they are sitting at their desk working on their computer. They are not up doing sports or some activity. And there’s a disconnect between the speed of the heart and the activity that that person is doing. The other manifestations can be a decrease in the cardiac performance such that someone feels lightheaded, short of breath and in very uncommon circumstances; atrial fib can be so rapid that it can be associated with blacking out.
Host: That’s good to know. So, I’m curious at Baylor Scott & White; how is AFib diagnosed and then how do you go about treating it?
Dr. Wheelan: The only way that atrial fib can be clearly diagnosed is with an EKG recording while the episode is occurring. There are other conditions which can cause the heart to be irregular. Atrial fib is a specific pattern of electrical abnormality in the heart. So, getting an EKG; that can be from an Apple iWatch, it can be from AliveCor monitor that can be connected to any smart phone. It can be from a medically prescribed monitor that a patient wears for variable lengths of time, anywhere from a couple of days up to a month.
Some patients experience atrial fib very, very infrequently and it can be sometimes difficult to diagnose but we fortunately do have a number of long-term strategies and there are even monitors that can be injected underneath the skin as an outpatient procedure with a little bit of local anesthetic that last for three years and sends regular telemeter data to an internet connection to help diagnose very difficult cardiovascular conditions.
Host: So, the EKG, what they are going to try and do is I guess reproduce the scenario within the hospital, maybe put you on a treadmill or something. But they do really need to see it as it’s happening so, if that doesn’t work, that’s when all of these techniques you are talking about or even wearing like the Apple iWatch might be helpful because it will record it if it’s happening outside the hospital and then you can analyze the data. Is that correct?
Dr. Wheelan: Exactly.
Host: In doing a little bit of research, I see that you are a cardiologist, but I’ve also heard that you are known as an electrophysiologist. Can you talk a little bit about what that means?
Dr. Wheelan: That’s a large medical term that basically means I’m an electrician of the heart. So, if you step back simplistically, you got plumbers and you got electricians. And I deal with all of the aspects of the electrical control system, the parts of the heart that regulate the rhythm, cause it to go out of rhythm and then techniques that can fix that through either medications or ablation procedures where we go inside the heart and freeze or spot weld some of these electrical short circuits to correct them back to normal or prevent them from shorting out in the first place.
The plumbers are the guys that go in and fix the blockages that are associated with heart attacks and cholesterol build up. Very simplistic, but it gets the point across.
Host: Yeah, for sure. So, it seems like there are a lot of mechanisms to figure out what is going on in terms of diagnosing what you have. You obviously have a specialty in figuring out that electrical work that’s going on in the heart; but maybe talk to people about once it is diagnosed, what can you do to help people with atrial fibrillation?
Dr. Wheelan: Well, the key point you made is we have to make the appropriate diagnosis. So, we need to correlate the symptoms or in some cases, asymptomatic atrial fib where the patient isn’t even aware of it and that can be more problematic because not being aware of it, it oftentimes doesn’t get treated until later in the disease process. And that has some other problems. But let’s say we made the diagnosis, then we want to try to determine are there specific risk factors that an individual can help modify that may reduce the episodes of a fib or assist in the management of that?
Those can be dietary issues, too much alcohol is a very common one, too much caffeine can sometimes play a role, obesity, sleep apnea, and substance use, so various dietary stimulants that people may be using to try to lose weight or some of these vitamin pills with various unknown ingredients in them can sometimes have a deleterious effect on the heart. Then we want to define if there are other specific medical problems. I mentioned one, sleep apnea, high blood pressure, other heart conditions where atrial fib may be associated with a leaky heart valve, blockage problems, various conditions where the heart muscle may thicken abnormally. And then there’s a large group of patients who have a term that we call idiopathic AFib where it’s probably related to a genetic predisposition. Oftentimes, there are other family members that may have had irregular heart rhythm problems in the past and they may be – the individual may have no other medical problems except atrial fibrillation and that represents a different category.
So, the approach to management is combinational. Look at those areas where the individual may be able to modify lifestyle factors which have an adverse impact on their cardiovascular wellness, manage those medical conditions such as blood pressure or sleep apnea, then look at strategies to deal with the atrial fibrillation and that may involve medications that help calm electrical irritability in the heart and more commonly today; we’re moving on to strategies where we actually go inside the heart, map out the electrical network and isolate those areas that are short circuiting, misbehaving and freeze them or use this other technology that I described as spot welding them to neutralize their ability to cause this short circuit that results in atrial fibrillation.
Host: So, Dr. Wheelan, as we wrap up here; I just wanted to know if there’s anything that you’d like to leave our audience, especially those that might be experiencing atrial fibrillation and haven’t really looked into it. What might you tell them around taking care of themselves and their heart?
Dr. Wheelan: Number one is to pursue a heart healthy lifestyle. But if you have symptoms; don’t be afraid to try to get a diagnosis. Some people wait too long and put off, put off and in any medical condition; if there is something more serious going on like atrial fib, our ability to give the patient a better outcome is much higher when we detect the process earlier on in the disease process. Go to your physician, say look I have these issues, what can we do to figure them out. Or we have a specialized center at Baylor in arrythmia management to help patients with this type of a condition and can provide them with many of the tools that we talked about.
Host: All right Dr. Wheelan, extremely informative and really appreciate your time today. That’s Dr. Kevin Wheelan, the Chief Medical Officer at Baylor Scott & White Heart & Vascular Hospital in Dallas. Thanks for checking out this episode of HeartSpeak. To find a specialist on the medical staff, please call 1-844-279-3627 or visit www.baylorhearthospital.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.
Living with Atrial Fibrillation
Prakash Chandran (Host): Have you ever felt like you heart was fluttering or pounding against your chest? If your heart races and even skips a beat and the feeling lasts for a few minutes; you could have a condition called atrial fibrillation. Let’s talk about it today with Dr. Kevin Wheelan, the Chief Medical Officer at Baylor Scott & White Heart and Vascular Hospital in Dallas. This is HeartSpeak, the podcast from Baylor Scott & White Heart and Vascular Hospital – in Dallas and in Fort Worth. I’m Prakash Chandran. So, Dr. Wheelan, let’s start with the basics around learning a little bit more about what atrial fibrillation or AFib is.
Kevin Wheelan, MD, FACC (Guest): Well Prakash, let’s start out with how the heart works normally. Heart is a mechanical pump that has an electrical control system very much like the spark plugs in your automotive engine. The timing of that is coordinated by a region called the sinus node, which is the normal timeclock that regulates your heart, helps slow it down when you go to sleep at night, helps it speed up when you need to do your normal daily activities or when you start doing more aggressive physical sports, running, jogging, et cetera.
That electrical system is complicated in that it coordinates the top and bottom half, right and left side of your heart and keeps the valves opening and closing as efficiently as possible. Atrial fibrillation is a short circuit in the control mechanism in the top part of the heart causing it to be very, very erratic and frequently very rapid. And much like if you were driving your car on the ice and your wheels started spinning, speedometer is going fast, you are just not moving; the heart is not pumping effectively when it goes into atrial fibrillation.
Host: I’m wondering, I feel like I have experienced some of this before when I’m working out really hard, but I’m curious to how someone might know that they have atrial fibrillation and is it common?
Dr. Wheelan: It’s a common electrical problem that occurs in up to 10% of the population by the time they are in their 80s. We tend to see it begin in the 40s, 50s and increasingly after that and there are different risk factors associated with AFib. Probably the most important thing you hit on is if an individual feels like their heart is skipping, racing, very fluttery sensation in their chest; that might be the manifestations of atrial fib that they would be aware of in terms of feeling this sensation of irregular, rapid beating. It could also be associated with difficulty breathing, doing normal activities that you would normally be able to do without any trouble, all of the sudden become much more difficult to do.
There can be lightheadedness, shortness of breath, and in some individuals, there can be chest discomfort associated with it because if the heart is beating overly rapidly; it’s taxing itself and it can manifest in many different ways in individual patients depending on other conditions that they may have.
Host: Okay and what are the risks or dangers associated with atrial fibrillation? Is it just something that the individual has to deal with, or can it lead to other more serious things?
Dr. Wheelan: There are three things that are associated with atrial fib. One, having atrial fibrillation is associated with a slightly reduced life expectancy. That’s very complicated and may be due to other cardiovascular problems that a person has, and atrial fib is one of those manifestations. More commonly, atrial fib divides itself into two categories. It increases one’s risk of having a stroke which is a blood clot that breaks loose and goes to the brain and causes an impairment of brain function. More commonly, atrial fib manifests in an alteration in the efficiency of the heart to do it’s job. So, people experience the symptoms we’ve talked about, uncomfortable sensation of something just not feeling right in their chest, their heart is fluttering or racing at a time when they are sitting at their desk working on their computer. They are not up doing sports or some activity. And there’s a disconnect between the speed of the heart and the activity that that person is doing. The other manifestations can be a decrease in the cardiac performance such that someone feels lightheaded, short of breath and in very uncommon circumstances; atrial fib can be so rapid that it can be associated with blacking out.
Host: That’s good to know. So, I’m curious at Baylor Scott & White; how is AFib diagnosed and then how do you go about treating it?
Dr. Wheelan: The only way that atrial fib can be clearly diagnosed is with an EKG recording while the episode is occurring. There are other conditions which can cause the heart to be irregular. Atrial fib is a specific pattern of electrical abnormality in the heart. So, getting an EKG; that can be from an Apple iWatch, it can be from AliveCor monitor that can be connected to any smart phone. It can be from a medically prescribed monitor that a patient wears for variable lengths of time, anywhere from a couple of days up to a month.
Some patients experience atrial fib very, very infrequently and it can be sometimes difficult to diagnose but we fortunately do have a number of long-term strategies and there are even monitors that can be injected underneath the skin as an outpatient procedure with a little bit of local anesthetic that last for three years and sends regular telemeter data to an internet connection to help diagnose very difficult cardiovascular conditions.
Host: So, the EKG, what they are going to try and do is I guess reproduce the scenario within the hospital, maybe put you on a treadmill or something. But they do really need to see it as it’s happening so, if that doesn’t work, that’s when all of these techniques you are talking about or even wearing like the Apple iWatch might be helpful because it will record it if it’s happening outside the hospital and then you can analyze the data. Is that correct?
Dr. Wheelan: Exactly.
Host: In doing a little bit of research, I see that you are a cardiologist, but I’ve also heard that you are known as an electrophysiologist. Can you talk a little bit about what that means?
Dr. Wheelan: That’s a large medical term that basically means I’m an electrician of the heart. So, if you step back simplistically, you got plumbers and you got electricians. And I deal with all of the aspects of the electrical control system, the parts of the heart that regulate the rhythm, cause it to go out of rhythm and then techniques that can fix that through either medications or ablation procedures where we go inside the heart and freeze or spot weld some of these electrical short circuits to correct them back to normal or prevent them from shorting out in the first place.
The plumbers are the guys that go in and fix the blockages that are associated with heart attacks and cholesterol build up. Very simplistic, but it gets the point across.
Host: Yeah, for sure. So, it seems like there are a lot of mechanisms to figure out what is going on in terms of diagnosing what you have. You obviously have a specialty in figuring out that electrical work that’s going on in the heart; but maybe talk to people about once it is diagnosed, what can you do to help people with atrial fibrillation?
Dr. Wheelan: Well, the key point you made is we have to make the appropriate diagnosis. So, we need to correlate the symptoms or in some cases, asymptomatic atrial fib where the patient isn’t even aware of it and that can be more problematic because not being aware of it, it oftentimes doesn’t get treated until later in the disease process. And that has some other problems. But let’s say we made the diagnosis, then we want to try to determine are there specific risk factors that an individual can help modify that may reduce the episodes of a fib or assist in the management of that?
Those can be dietary issues, too much alcohol is a very common one, too much caffeine can sometimes play a role, obesity, sleep apnea, and substance use, so various dietary stimulants that people may be using to try to lose weight or some of these vitamin pills with various unknown ingredients in them can sometimes have a deleterious effect on the heart. Then we want to define if there are other specific medical problems. I mentioned one, sleep apnea, high blood pressure, other heart conditions where atrial fib may be associated with a leaky heart valve, blockage problems, various conditions where the heart muscle may thicken abnormally. And then there’s a large group of patients who have a term that we call idiopathic AFib where it’s probably related to a genetic predisposition. Oftentimes, there are other family members that may have had irregular heart rhythm problems in the past and they may be – the individual may have no other medical problems except atrial fibrillation and that represents a different category.
So, the approach to management is combinational. Look at those areas where the individual may be able to modify lifestyle factors which have an adverse impact on their cardiovascular wellness, manage those medical conditions such as blood pressure or sleep apnea, then look at strategies to deal with the atrial fibrillation and that may involve medications that help calm electrical irritability in the heart and more commonly today; we’re moving on to strategies where we actually go inside the heart, map out the electrical network and isolate those areas that are short circuiting, misbehaving and freeze them or use this other technology that I described as spot welding them to neutralize their ability to cause this short circuit that results in atrial fibrillation.
Host: So, Dr. Wheelan, as we wrap up here; I just wanted to know if there’s anything that you’d like to leave our audience, especially those that might be experiencing atrial fibrillation and haven’t really looked into it. What might you tell them around taking care of themselves and their heart?
Dr. Wheelan: Number one is to pursue a heart healthy lifestyle. But if you have symptoms; don’t be afraid to try to get a diagnosis. Some people wait too long and put off, put off and in any medical condition; if there is something more serious going on like atrial fib, our ability to give the patient a better outcome is much higher when we detect the process earlier on in the disease process. Go to your physician, say look I have these issues, what can we do to figure them out. Or we have a specialized center at Baylor in arrythmia management to help patients with this type of a condition and can provide them with many of the tools that we talked about.
Host: All right Dr. Wheelan, extremely informative and really appreciate your time today. That’s Dr. Kevin Wheelan, the Chief Medical Officer at Baylor Scott & White Heart & Vascular Hospital in Dallas. Thanks for checking out this episode of HeartSpeak. To find a specialist on the medical staff, please call 1-844-279-3627 or visit www.baylorhearthospital.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.