Transcription:
Atrial Fibrillation: Symptoms, Risk Factors and Treatment

Deborah Howell (Host): Hello, and welcome to our show. You are listening to Weekly Dose of Wellness brought to you by MemorialCare Healthsystem. I'm Deborah Howell and today's guest is Dr. Sinjin Lee. Dr. Lee graduated cum laude from the University of California, Berkeley. He completed his MD degree at Albert Einstein College of Medicine in New York where he graduated AOA with additional distinction for research in cardiology. Dr. Lee went on to satisfy his internship and residency requirements at the Duke Medical Center in Durham, North Carolina. He continues his four-year cardiology fellowship training in both cardiology and electrophysiology at Beth Israel Deaconess, a teaching hospital of Harvard Medical School in Boston. He's board certified in both cardiology and electrophysiology and is now affiliated with Saddleback Memorial Medical Center. Welcome to you, Dr. Lee.

Dr. Lee: Good morning. Thanks for having me, Deborah.

Deborah: Today, we're going to be talking about atrial fibrillation. We hear so much about it but many of us still don't really have a good idea what it involves. In laymen's terms, what is atrial fibrillation?

Dr. Lee: Sure, I'll gladly talk about this topic which is a very important condition. Atrial fibrillation essentially refers to an abnormal electrical activity inside the heart which leads to a disorganized electrical activity in the atrium which is the upper chamber of the heart essentially.

Deborah: What would cause that kind of activity?

Dr. Lee: Unfortunately, we still do not know the actual cause of this. However, we do know that it is usually a condition of the aging population. This is a very common problem and it is known that by the time you reach the age of 80, approximately 10 percent of population have this condition.

Deborah: Really? And still really the cause is unknown.

Dr. Lee: It is unknown. There are many risk factors. Certainly there are some genetic components to it. And then there are some patients where the risk factors include the usual hypertension, structural heart disease, diabetes. The typical cardiac risk factors are certainly increased risks for developing atrial fibrillation. However, there are even situations where people are extremely healthy, a marathon runner for example, who develops this condition at a young age.

Deborah: Wow. Okay. So this is happening, this electrical activity. What are the symptoms that a patient feels?

Dr. Lee: To be honest with you, surprisingly, the majority of the patients don't feel this. This is actually most commonly discovered accidentally if you happen to just go see your doctor and your physician might just note that you have an irregular heart rhythm, for example. Or they may do a very simple test, something called an EKG, which stands for electrocardiogram, where they accidentally find this prior to undergoing surgery, for example.

Deborah: So people are walking around, this is happening in their hearts, they don't know it, a doctor discovers it by accident, and then what happens next?

Dr. Lee: I would say that about half of the patients, these conditions are discovered by accident. There are patients where they feel irregular heartbeats, palpitations, for example. When the patients are elderly, they tend to feel more of a fatigue or just low energy. Rarely, some patients might just feel dizzy, or they describe that as giddiness, and they go to see a doctor and this is what's discovered.

Deborah: Interesting. So this is different from congenital heart disease?

Dr. Lee: Very different. Congenital heart disease is a very generic, nonspecific term where you're born with any type of a heart condition. Atrial fibrillation is funny in that it's an electrical problem. So if you actually look at the heart initially, there is nothing wrong with the heart itself. The electrical conduction problem is not something that you can see with your own eyes. However, if you leave this alone for a long time, this does eventually lead to enlarged heart and other heart problems.

Deborah: That was what my next question is, why should we be concerned about it?

Dr. Lee: Sure. So, atrial fibrillation by itself is not a life-threatening condition. However, there are two things that can lead to a very serious condition. One is a stroke and the second problem is congestive heart failure. Its symptoms consist of being short of breath, your legs swollen, and not being able to breathe well at all especially when you're lying down.

Deborah: Yeah. That would be a concern.

Dr. Lee: Yes.

Deborah: Does A-fib itself put a patient at risk for stroke and heart failure?

Dr. Lee: It does. The reason that being is when you're in atrial fibrillation, because your heart is not having a normal electrical activity, the blood flow going through the heart gets distorted. What happens is that the chambers inside the heart begin to form clots. Those clots can be sent out of the heart and the first place that the blood goes out of the heart is to your brain which is where the stroke is.

Deborah: Sure.

Dr. Lee: One of the common findings of atrial fibrillation is that your heart is racing. So you may not be aware of it but even when you're resting and just relaxing, when you're in atrial fibrillation, your heart may be racing at 120 beats per minute.

Deborah: This happened to my sister and it happens only when she's driving.

Dr. Lee: Really? And contrary to belief, these things actually don't happen with activity. They usually happen right after activities or when you're at rest. Your heart, normally, it's supposed to race when you're angry or when you're emotionally upset or exercising. But when you're relaxed, your heart should not be racing that fast. And if it's doing that for a while, your heart eventually will tire out and lead to congestive heart failure.

Deborah: Do you think it might be stress related even though a person is resting? It might be a delayed reaction from earlier stress?

Dr. Lee: Sure. That is actually a very common response by a patient, is that, "Oh, doc, I think I'm just going through a lot of stress." We don't believe so. Certainly, stress never helps you. Stress certainly increases the risk of heart disease and certainly it doesn't help in terms of developing anything that's related to a cardiac-related condition. But stress alone is not the trigger of atrial fibrillation. There are also other common myths about atrial fibrillation trigger and they include chocolates, caffeine, any of those sorts, and none of them had actually been convincingly shown to be the trigger of atrial fibrillation.

Deborah: It remains a mystery. Well, I'm sure you guys will figure it out someday.

Dr. Lee: Right. The only two that we know for sure has an association is alcohol consumption as well as having a condition called sleep apnea, and if untreated, can lead to a high risk of having atrial fibrillation.

Deborah: Okay. So now, let's talk about prevention.

Dr. Lee: Sure. Well, because it's a condition that is, first of all, hard to detect, certainly the first thing you can do is avoid two known risk factors. One is if you drink fairly heavily, I think you should certainly cut that down. That's a common advice from physicians to patients.

Deborah: And what's your definition of fairly heavily?

Dr. Lee: I would say for men, one to two drinks a day is fair. For women, a glass a day is fine. What you cannot do is save it for an entire week and then drink all seven drinks in a day. That's not what you should be doing.

Deborah: Binging, yeah.

Dr. Lee: Right. But certainly, a small dose of alcoholic beverages actually has a paradoxical effect of being good for the heart. So it is okay to drink but everything in moderation, obviously.

Deborah: Go for the red wine, ladies.

Dr. Lee: Exactly. But in terms of the sleep apnea, that is a very common condition. It is almost an epidemic in the United States because of the increasing obesity in the country. Some of the telltale signs of a sleep apnea would be heavy snoring. Especially if you stop breathing in the middle of the night and your partner noticed this, you should certainly be evaluated for sleep apnea and have that treated because that will certainly lower your risk of atrial fibrillation.

Deborah: Okay. Now that we've prevented it, let's also talk about those who have sadly given into it. So we need some treatment options.

Dr. Lee: Sure. The first thing to say about atrial fibrillation is unfortunately, there is no perfect cure for this rhythm. Because it can lead to a stroke, the most important therapy for atrial fibrillation is that when you're diagnosed with it, you need to be on a blood thinner. Traditionally, you have to be on a medication called warfarin or Coumadin which a lot of patients don't like taking because it requires you to monitor your blood. But for the past three years, there have been some alternative blood thinners that came out on the market that does not require blood checks anymore, which makes it a little more convenient to the patient. The second issue is that because you can develop congestive heart failure, which is due to your heart racing uncontrollably, the usual medications that you are initially placed on are what we call rate control medications. If they are not effective, the cardiologist, usually electrophysiologist, will start you on a medication called antiarrhythmic medication, which are designed to keep you in a normal rhythm.

Deborah: Are these effective?

Dr. Lee: They are about 50/50. They either work or they don't. The blood thinners are effective. But in terms of the rate controlling and the rhythm controlling medications, they are about 50/50. And as a result, if the medicines are not effective, certainly the patients also have an option to undergo surgical procedures sometimes known as ablation, which is what electrophysiologists usually provide.

Deborah: I think we need a whole another show on ablations. That's what I think.

Dr. Lee: Yes. It's a pretty complex area and it is an extensive topic.

Deborah: Well, we thank you so much. Our time, speaking of racing, has raced. We really appreciate you finding time to talk to us today about the symptoms, the risk factors, and the treatment of atrial fibrillation.

Dr. Lee: Thank you for having me, Deborah.

Deborah: That's what it's about. It's about getting information out to the public. We hope you've enjoyed our show today. It has been a real pleasure to have Dr. Sinjin Lee with us. And of course, you are joining us again next time and we'll be exploring another Weekly Dose of Wellness. It's all brought to you by MemorialCare Healthsystem. We hope you have a fantastic, healthy, preventive day. I'm Deborah Howell. Have a wonderful one.