Over the past two decades, death rates from atrial fibrillation – either as the main or underlying cause – have doubled. Detecting and treating this potentially fatal condition is a priority at Florida Hospital.
An Arrhythmia and Ablation Center of Excellence, Florida Hospital Cardiovascular Institute helps people avoid a life-threatening stroke by treating atrial fibrillation as early as possible, before complications arise.
Listen in as Christian Fisher, RN, BSN, MBA, explains Atrial Fibrillation and the treatment options available to help you manage your Afib.
Selected Podcast
Atrial Fibrillation (AFIB): What You Need To Know
Featured Speaker:
Christian Fisher, RN, BSN, MBA
Christian Fisher RN, BSN, MBA is the Director of Cardiovascular Services at Florida Hospital Memorial Medical Center and Florida Hospital Flagler. Transcription:
Atrial Fibrillation (AFIB): What You Need To Know
Melanie Cole (Host): As many as 6 million people in the United States have atrial fibrillation and with the aging of the US population, this number is expected to increase. My guest today is Christian Fisher. He's the director of cardiovascular services at Florida Hospital Memorial Medical Center in Florida Hospital Flagler. Welcome to the show, Christian. Tell us what is atrial fibrillation?
Christian Fisher (Guest): Atrial fibrillation is essentially a condition where the top two chambers of the heart, the atria, which pump blood into the bottom two chambers of the heart, the ventricles, those atria quiver. Instead of actually pumping blood into the ventricles, they basically shake, vibrate, or quiver. As a result, blood does not flow very effectively from the atrium down to the ventricles, you have reduced blood flow, and it tends to cause patients to have a number of symptoms as a result.
Melanie: Who would be at risk for AFib?
Christian: There are a number of people at risk. Those who are of advanced age, high blood pressure; those who have some kind of previous heart disease or valve problem; those who drink alcohol--significant alcohol consumption; those with a family history of AFib also tend to get it themselves; sleep apnea is another one where we're finding a lot of patients with it. Oddly enough, athletes. Some athletes are prone to it, particularly those who have had some sort of rapid heart rate condition when they have exercised, and, you know, just some other chronic conditions that patients may have, such as thyroid problems, diabetes, asthma, a few of those, as well.
Melanie: So, would someone know they have atrial fibrillation? Would they feel that flutter you described? What are some symptoms?
Christian: They may or may not. Some people feel it more severely than others. They could feel this fluttering. The other symptoms really are weakness, shortness of breath, particularly in areas where they were walking, doing whatever, just a week or two before, and now, all of a sudden, they have this problem where they don't have the energy, they're short of breath, what have you. A lot of times, you’ll find those patients are actually in an episode of AFib and it's just night and day difference from normal rhythm of the heart to AFib and how it affects people in even their activities of daily living, not to mention exercise or something more strenuous.
Melanie: And, are there some complications to it not being treated or diagnosed?
Christian: Absolutely. The biggest complication, really, is stroke. One of the problems when the atrium is quivering or vibrating like that, as you can imagine, blood is not flowing effectively, as we said before. One of the problems is outcropping off the left atrium, called the left atrial appendage. And, in that outcropping, because blood is not flowing effectively, blood kind of pools there or stagnates, much like it would in a pond or a stream where it's not flowing well and where blood pools and collects, it's going to develop a high risk for clot formation. And then, those clots, unfortunately, find their way down into the ventricles and get ejected into the body and as those clots travel around through various arteries in a patient, they can get lodged, unfortunately, particularly in the brain, and cause stroke.
Melanie: So, then, if somebody is diagnosed--first how do they get diagnosed?
Christian: There's a number of ways. Oftentimes, the patients will complain of symptoms as we described before and then they'll go see their doctor and their doctor will check their pulse, just even on a routine check and we can find that irregular heartbeat. And so, because the atrium are quivering, the ventricles don't know that they're not in normal rhythm, and the ventricles, the lower two chambers, don't know how to pump effectively, so it gets off-rhythm. So, you'll feel this erratic sort of pulse when you feel your pulse. It will be you know, anywhere from 60 beats to 120 beats and it's all over the place. And so, that's one. They'll diagnose it by EKG, putting those leads on your chest and watching the tracing, as well. So, they can feel it, and they can also see it through EKG.
Melanie: Once it is diagnosed, then what's the first line of defense, Christian?
Christian: Well, initially, it's seeing if we can do some sort of rate control. Oftentimes, patients have a much higher heart rate than is typical for them, so they're going to be above 100, particularly if they're in an AFIB episode. So, we want to control that rate. So, medication is one way that we treat it. The other is past that to see how long has a patient been in AFib and would they be a candidate for a process called cardio-version, where we use a small amount of electrical energy; people are put into a twilight sleep. They use a small amount of electrical energy to basically reset the heart into its normal rhythm. And so those are the two initial treatments; medication and that, and of course, if a patient remains in AFib, we need to look at blood thinners for them to prevent that risk of stroke.
Melanie: If they do start with blood thinners, or blood clot prevention medications, is this something now that they're going to have to be on for their life?
Christian: This is a life-long thing while they remain in AFib, yes. And so, whether they're on the standard, which is Coumadin, which is a daily medication, or one of the newer drugs, where you take it once a day, but you don't have to be tested. That's the big problem with Coumadin. There has to be regular testing because of the fluctuations and the variety of thinness of the blood, but with the other medications that are out there, and some we've seen on TV, they're called novel anti-coagulants, and those are only taken once a day and we don't test for those. The patient is just anti-coagulated and protected from stroke while they're on those.
Melanie: And, if you use one of those procedures for rhythm control, does it solve the problem? Can it come back afterwards if they have a catheter ablation or one of these procedures?
Christian: Yes, it can come back. Catheter ablation is a significant treatment, usually after cardio-version does not work and the patient does not remain in rhythm. So, first it's cardio-version, then it's ablation, but there's still always a risk of it coming back and it's always important that people are managing the lifestyle changes that are necessary in order to help prevent that from coming back.
Melanie: And, does someone with AFIB sometimes need a pacemaker?
Christian: Sometimes they do because the medications, or the heart itself, that we use to keep rate under control, sometimes the heart is just too slow. The ventricles are pumping too slow and so a pacemaker is needed. We see that sometimes more as patients age, more likely as advanced age comes into it, a patient will need a pacemaker.
Melanie: So, Christian, are there any lifestyle modifications that can help with these treatments, go as an adjunct to them, or possibly prevent AFib?
Christian: Certainly, and they're a lot of things that go hand-in-hand with just good heart care. One is a good diet that's free of excess salt and we all know the bad stuff: the fats; the cholesterol, and all of that. We want to avoid that whenever possible. The excess salt as well, really as much salt as we can get rid of, the better. And then, the next thing is alcohol. Patients who are prone to this, even one or two drinks can be serious to bring on an AFib episode; it's been shown in the literature. But, typically, it's more significant alcohol consumption, so you want to get rid of that, altogether. And then, significant rest at night and just in general. A good pattern of getting regular rest every day--a good 6-8 hours of sleep at night--all of that really does make for a difference in treating AFib. And then, finally, diet also plays a part if you're on Coumadin because there is a particular nutrient called Vitamin K that is present in green, leafy vegetables and in other areas. We're not saying you shouldn't eat green, leafy vegetables, or broccoli, or what have you, but if you're going to eat it, you stay consistent with it so that the Vitamin K level is consistent in your body and then we can give you enough Coumadin to make your blood thin enough. Vitamin K acts as sort of a block to the Coumadin. So, you don't want to fluctuate on your diet. You want to stay on a consistent diet if you're going to be on a blood thinner.
Melanie: Christian, it's such great information. Please wrap it up for us in the last few minutes. Give your best advice for someone to live a long, healthy life, even if they do have atrial fibrillation, and why they should come to Florida Hospital Memorial Medical Center for their care.
Christian: Well, that is a very important part of dealing AFib--learning how to live with it, and so those things I outlined before: good diet, a little exercise--as much as you get into--and watching your alcohol consumption, but in particular, the most important reason to come to Florida Hospital Memorial Medical Center. We have the staff, the expertise, and the ability to help change a person's life in this regard in order to manage this disease and, hopefully, actually cure it and eliminate it from affecting the person's life.
Melanie: Thank you so much for being with us, and if you'd like to take a quiz to assess your risk of heart disease, please go to www.fhheart.com. That's www.fhheart.com. You're listening to Health Chats by Florida Hospital. This is Melanie Cole. Thanks so much for listening.
Atrial Fibrillation (AFIB): What You Need To Know
Melanie Cole (Host): As many as 6 million people in the United States have atrial fibrillation and with the aging of the US population, this number is expected to increase. My guest today is Christian Fisher. He's the director of cardiovascular services at Florida Hospital Memorial Medical Center in Florida Hospital Flagler. Welcome to the show, Christian. Tell us what is atrial fibrillation?
Christian Fisher (Guest): Atrial fibrillation is essentially a condition where the top two chambers of the heart, the atria, which pump blood into the bottom two chambers of the heart, the ventricles, those atria quiver. Instead of actually pumping blood into the ventricles, they basically shake, vibrate, or quiver. As a result, blood does not flow very effectively from the atrium down to the ventricles, you have reduced blood flow, and it tends to cause patients to have a number of symptoms as a result.
Melanie: Who would be at risk for AFib?
Christian: There are a number of people at risk. Those who are of advanced age, high blood pressure; those who have some kind of previous heart disease or valve problem; those who drink alcohol--significant alcohol consumption; those with a family history of AFib also tend to get it themselves; sleep apnea is another one where we're finding a lot of patients with it. Oddly enough, athletes. Some athletes are prone to it, particularly those who have had some sort of rapid heart rate condition when they have exercised, and, you know, just some other chronic conditions that patients may have, such as thyroid problems, diabetes, asthma, a few of those, as well.
Melanie: So, would someone know they have atrial fibrillation? Would they feel that flutter you described? What are some symptoms?
Christian: They may or may not. Some people feel it more severely than others. They could feel this fluttering. The other symptoms really are weakness, shortness of breath, particularly in areas where they were walking, doing whatever, just a week or two before, and now, all of a sudden, they have this problem where they don't have the energy, they're short of breath, what have you. A lot of times, you’ll find those patients are actually in an episode of AFib and it's just night and day difference from normal rhythm of the heart to AFib and how it affects people in even their activities of daily living, not to mention exercise or something more strenuous.
Melanie: And, are there some complications to it not being treated or diagnosed?
Christian: Absolutely. The biggest complication, really, is stroke. One of the problems when the atrium is quivering or vibrating like that, as you can imagine, blood is not flowing effectively, as we said before. One of the problems is outcropping off the left atrium, called the left atrial appendage. And, in that outcropping, because blood is not flowing effectively, blood kind of pools there or stagnates, much like it would in a pond or a stream where it's not flowing well and where blood pools and collects, it's going to develop a high risk for clot formation. And then, those clots, unfortunately, find their way down into the ventricles and get ejected into the body and as those clots travel around through various arteries in a patient, they can get lodged, unfortunately, particularly in the brain, and cause stroke.
Melanie: So, then, if somebody is diagnosed--first how do they get diagnosed?
Christian: There's a number of ways. Oftentimes, the patients will complain of symptoms as we described before and then they'll go see their doctor and their doctor will check their pulse, just even on a routine check and we can find that irregular heartbeat. And so, because the atrium are quivering, the ventricles don't know that they're not in normal rhythm, and the ventricles, the lower two chambers, don't know how to pump effectively, so it gets off-rhythm. So, you'll feel this erratic sort of pulse when you feel your pulse. It will be you know, anywhere from 60 beats to 120 beats and it's all over the place. And so, that's one. They'll diagnose it by EKG, putting those leads on your chest and watching the tracing, as well. So, they can feel it, and they can also see it through EKG.
Melanie: Once it is diagnosed, then what's the first line of defense, Christian?
Christian: Well, initially, it's seeing if we can do some sort of rate control. Oftentimes, patients have a much higher heart rate than is typical for them, so they're going to be above 100, particularly if they're in an AFIB episode. So, we want to control that rate. So, medication is one way that we treat it. The other is past that to see how long has a patient been in AFib and would they be a candidate for a process called cardio-version, where we use a small amount of electrical energy; people are put into a twilight sleep. They use a small amount of electrical energy to basically reset the heart into its normal rhythm. And so those are the two initial treatments; medication and that, and of course, if a patient remains in AFib, we need to look at blood thinners for them to prevent that risk of stroke.
Melanie: If they do start with blood thinners, or blood clot prevention medications, is this something now that they're going to have to be on for their life?
Christian: This is a life-long thing while they remain in AFib, yes. And so, whether they're on the standard, which is Coumadin, which is a daily medication, or one of the newer drugs, where you take it once a day, but you don't have to be tested. That's the big problem with Coumadin. There has to be regular testing because of the fluctuations and the variety of thinness of the blood, but with the other medications that are out there, and some we've seen on TV, they're called novel anti-coagulants, and those are only taken once a day and we don't test for those. The patient is just anti-coagulated and protected from stroke while they're on those.
Melanie: And, if you use one of those procedures for rhythm control, does it solve the problem? Can it come back afterwards if they have a catheter ablation or one of these procedures?
Christian: Yes, it can come back. Catheter ablation is a significant treatment, usually after cardio-version does not work and the patient does not remain in rhythm. So, first it's cardio-version, then it's ablation, but there's still always a risk of it coming back and it's always important that people are managing the lifestyle changes that are necessary in order to help prevent that from coming back.
Melanie: And, does someone with AFIB sometimes need a pacemaker?
Christian: Sometimes they do because the medications, or the heart itself, that we use to keep rate under control, sometimes the heart is just too slow. The ventricles are pumping too slow and so a pacemaker is needed. We see that sometimes more as patients age, more likely as advanced age comes into it, a patient will need a pacemaker.
Melanie: So, Christian, are there any lifestyle modifications that can help with these treatments, go as an adjunct to them, or possibly prevent AFib?
Christian: Certainly, and they're a lot of things that go hand-in-hand with just good heart care. One is a good diet that's free of excess salt and we all know the bad stuff: the fats; the cholesterol, and all of that. We want to avoid that whenever possible. The excess salt as well, really as much salt as we can get rid of, the better. And then, the next thing is alcohol. Patients who are prone to this, even one or two drinks can be serious to bring on an AFib episode; it's been shown in the literature. But, typically, it's more significant alcohol consumption, so you want to get rid of that, altogether. And then, significant rest at night and just in general. A good pattern of getting regular rest every day--a good 6-8 hours of sleep at night--all of that really does make for a difference in treating AFib. And then, finally, diet also plays a part if you're on Coumadin because there is a particular nutrient called Vitamin K that is present in green, leafy vegetables and in other areas. We're not saying you shouldn't eat green, leafy vegetables, or broccoli, or what have you, but if you're going to eat it, you stay consistent with it so that the Vitamin K level is consistent in your body and then we can give you enough Coumadin to make your blood thin enough. Vitamin K acts as sort of a block to the Coumadin. So, you don't want to fluctuate on your diet. You want to stay on a consistent diet if you're going to be on a blood thinner.
Melanie: Christian, it's such great information. Please wrap it up for us in the last few minutes. Give your best advice for someone to live a long, healthy life, even if they do have atrial fibrillation, and why they should come to Florida Hospital Memorial Medical Center for their care.
Christian: Well, that is a very important part of dealing AFib--learning how to live with it, and so those things I outlined before: good diet, a little exercise--as much as you get into--and watching your alcohol consumption, but in particular, the most important reason to come to Florida Hospital Memorial Medical Center. We have the staff, the expertise, and the ability to help change a person's life in this regard in order to manage this disease and, hopefully, actually cure it and eliminate it from affecting the person's life.
Melanie: Thank you so much for being with us, and if you'd like to take a quiz to assess your risk of heart disease, please go to www.fhheart.com. That's www.fhheart.com. You're listening to Health Chats by Florida Hospital. This is Melanie Cole. Thanks so much for listening.