Cheryl Martin (Host): How do you best navigate atrial
fibrillation, also known as AFib? In this episode, we take a closer look into
the intricate workings of AFib, what it is, and explore its causes, symptoms,
and potential complications. Here to cover it all, is Heidi Chaney, Doctor of
Nursing Practice in the Jefferson Healthcare Cardiology Clinic.

 This is To Your Health,
a podcast from Jefferson Healthcare. I'm Cheryl Martin. Heidi, so glad you're
here to help us navigate the world of AFib.

Heide Chaney, DNP, ARNP, FNP-C: Thank you for having me
again, Cheryl.

Host: Now, what exactly is atrial fibrillation and is it
serious?

Heide Chaney, DNP, ARNP, FNP-C: Well, atrial
fibrillation, as you pointed out, is commonly called AFib. It's a type of
abnormal heart rhythm where the heart begins to beat irregularly, and it often
beats faster than normal. In the clinic, I'm able to draw a picture for
patients because it seems to better explain what's going on in the heart.

I obviously can't do that in a podcast. But I can have you
picture in your mind a two-story house with two rooms on the bottom floor, and
two rooms on the top floor. These four rooms represent the four chambers of the
heart. Two atria on the top and two ventricles on the bottom. A person running
from the top floor to the bottom floor represents normal electrical activity in
the heart.

So electricity starts in the upper part of the heart or the
atria and travels to the bottom part of the heart or the ventricle. This
electricity then stimulates the muscle, which causes the muscle to contract and
the heart to squeeze, and this is the heartbeat that you feel when you're
checking your own pulse.

Now, if you can picture multiple people running around
chaotically, bumping into one another before making their way to the bottom
floor in a very rapid and irregular pattern, this represents the electricity in
atrial fibrillation. All of the people are trying to get to the bottom, which
makes it a less effective and poorly organized system.

In other words, the heart is being told to contract over and
over again. This irregularly, irregular heart beat defines atrial fibrillation.

Host: That is a great example. So what causes AFib?

Heide Chaney, DNP, ARNP, FNP-C: Well, we don't always
know the cause of AFib, which makes it very difficult to treat. The tissue of
the heart can change over time, and this is a result of aging, heart disease,
infection, or in some people a genetic disease, and it leads to scarring,
inflammation, stretching, or thickening of the heart wall. And when this
damaged heart tissue is subjected to irregular electrical signals that come too
early or too often, atrial fibrillation can begin.

Host: So how do you know if you have AFib?

Heide Chaney, DNP, ARNP, FNP-C: Well, this is where it
gets a little tricky because some people with atrial fibrillation are
completely unaware they have it, while others have debilitating symptoms. So
how AFib presents is unique to each individual because everyone's heart is
different. Symptoms can range from simply noticing that you have an irregular
heartbeat to thumping in the chest, to breathlessness, anxiety, dizziness,
fatigue, weakness, or even chest pain. And what complicates the picture even
more is that AFib can be present all of the time or only part of the time. For
those individuals, episodes can occur a couple of times a year to multiple
times daily. Sometimes we pick up atrial fibrillation when we do a routine
electrocardiogram or ECG in the office.

For others, the symptoms may be strong enough that it causes
them to go to the emergency department. Now, an electrocardiogram or an ECG,
like I mentioned before, should be done to verify AFib. But there are a lot of
devices now available, including Apple and Fitbit watches, or a device called a
Kardia mobile device, for example, that can screen for atrial fibrillation.

Host: So what do you need to know if you have AFib?

Heide Chaney, DNP, ARNP, FNP-C: Well, in atrial
fibrillation, the heart muscle is quivering rather than squeezing in response
to electricity. Remember all of those people running circles in the upstairs
room and clamoring to get down the stairs. The electricity is coming from a
different place in the heart than what is normal, and it's firing irregularly
as compared to normal.

The squeeze or the muscle contraction is what keeps blood
moving through the heart. And when blood doesn't move well, clots form and
clots in the heart can easily travel to the brain where they can cause a
stroke. For this reason, those who have atrial fibrillation are typically
advised to start an anticoagulant, commonly called a blood thinner to help
reduce that risk of stroke.

Additionally, your heart is designed to beat 60 to 90 beats a
minute, except during exercise when it temporarily increases, and if the heart
beats too fast for too long, it gets tired and it doesn't function well.

Host: Now you mentioned blood thinner. Is there anything
else that can be done to treat atrial fibrillation?

Heide Chaney, DNP, ARNP, FNP-C: Sure. Atrial
fibrillation can be treated and treatment generally focuses on two areas. One
is reducing the risk of stroke, as we discussed above, and then the other is
slowing the heart rate. Now I'm going to use the house analogy throughout this
explanation to help you better understand the treatment options. We have two
strategies we can follow to slow the heart rate.

The first is to simply control the rate, and the second is to
promote a normal rhythm in the heart. There are medications, beta blockers,
calcium channel blockers, and digoxin that all work to simply slow the rate of
the heart. So this is like blocking the number of people that can get down the
stairs.

But sometimes this isn't enough to relieve symptoms or we're
simply unable to slow the heart rate sufficiently. Allowing the atrial
fibrillation to continue and simply controlling the rate doesn't seem as
glamorous as rhythm control. But in reality, people can live long and healthy
lives with ongoing AFib, as long as the ventricular or the bottom rate is in a
comfortable range. If we can't effectively control the heart rate, we can
attempt to control the rhythm, rather than the rate of the heart. And this can
be done with medications that can be used to chemically kind of push the heart
toward a normal rhythm and make it less likely for the AFib to return.

Kind of like posting a guard to only allow the regulars to go
down the stairs. Also, we can convert the heart's electricity back to its
normal pattern by shocking the heart. This is called a cardioversion, and this
is done under IV sedation at a hospital. If all of the above measures fail to
relieve symptoms, a specialist in electricity called an electrophysiologist can
float a catheter up through the groin, find the problematic electricity and
cauterize or freeze the tissue, effectively stopping that irregular rhythm.

This allows a normal electrical pattern of the heart to return,
and this is called an ablation. This is like closing an upstairs window so no
extra people can climb in and come down the stairs. Finally, tissue between the
upper and the lower part of the door can actually be disconnected, and this is
effectively shutting a door between the two floors of the house. This then
requires a pacemaker to allow the bottom part of the heart to receive
electricity.

Host: Heidi, for a person who has been diagnosed with
AFib, are there things that this person can do? Do you ever say you need to
change your diet? Is that a factor at all?

Heide Chaney, DNP, ARNP, FNP-C: Yeah, anyone can get
atrial fibrillation, but there are risk factors. So the risk of atrial
fibrillation, number one, it increases with age especially after the age of 65.
Now, AFib is rare in children. But if someone in your family had AFib, you have
a higher risk of AFib because there are genetic mutations that have been found
that could raise your risk. But lifestyle can significantly affect your risk as
well. Alcohol can be a trigger for atrial fibrillation. For some people, a
modest amount can trigger it, but large amounts or particularly binge drinking
is quite problematic. Illegal drugs such as cocaine, methamphetamine and other
illegal street drugs, they can trigger atrial fibrillation or make it worse.

There are multiple studies that found smoking, including
secondhand smoke, can make atrial fibrillation worse. Stress and panic
disorders can increase your risk. And interestingly, in some people, endurance
sports or people who physically exert themselves, can lead to a higher risk of
atrial fibrillation, but at the same time, moderate physical activity can have
a protective effect that can lower your risk of atrial fibrillation, as well as
other heart diseases.

Sometimes though, atrial fibrillation happens for no obvious
reason. My patients are frequently searching for something they did to cause
atrial fibrillation, but the reality is they may not know. About 10% of the
population over age 80 goes into atrial fibrillation simply because they're
over age 80.

In fact, we're seeing a higher incidence of atrial fibrillation
than ever before. This is simply because we are living longer. It's projected
that the number of atrial fibrillation cases will reach over 12.1 million by
2030.

Host: Heidi Chaney, this has been so informative, so
helpful. Thank you for covering this topic of AFib, what it is, how to
recognize it and treat it. Thank you so much.

Heide Chaney, DNP, ARNP, FNP-C: You're welcome. Thank
you for having me.

Host: If you'd like to book an appointment today, call
the Jefferson Healthcare Cardiology Clinic at 360-344-1001. That's
360-344-1001.

And if you found this podcast helpful, please share it on your
social channels. You can check out the full podcast library for other topics of
interest to you at jeffersonhealthcare.org. That's jeffersonhealthcare.org.
This is To Your Health, a podcast from Jefferson Healthcare. Thanks for
listening.