Transcription:
What is AFib or Atrial Fibrillation

Caitlin Whyte: Atrial fibrillation or AFib is the most common type of sustained cardiac arrhythmia. So to tell us more about it is Dr. Neel Khanna, the Medical Director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall.

This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm your host, Caitlin Whyte. So doctor, to start us off, what is atrial fibrillation? What is going on in our chest if and when this happens?

Neel Khanna, MD, MPH: So, you know, just in plain sight what's happening is that, and it will be recognized on an EKG most often, is that your heart is in a disorganized rhythm. It's not a normal way that the heart beats where there's an impulse coming from the top of the heart that gets transmitted downwards. It's what we termed disorganized. So the top part of the whole heart is fibrillating or basically quivering instead of pumping and so that can cause some problems.

Mainly patients may feel that their heart is either racing, what we term as palpitations. They may feel lightheaded or some patients just feel that they're more short of breath than they were before because instead of their heart rate being at 70 beats per minute, which is the normal, AFib tends to go very quickly. So they may be just resting, watching TV, and they'll notice that they feel their heart beating and their heart rate is in the 110s or 120s. And that's a little bit of a tip-off to know that, you know, their heart is not in a normal rhythm.

Caitlin Whyte: Is there any certain population or group who is more at risk?

Neel Khanna, MD, MPH: Yeah. Anybody with heart disease is at an increased risk of atrial fibrillation. Also people who come in with strokes, really atrial fibrillation should be ruled out because, as I mentioned before, the top part of the heart is fibrillating and not pumping as we expected. When the heart is pumping normally, the blood is in continuous flow and it doesn't sit still long enough to clot.

If someone's heart is in atrial fibrillation, that top part of the heart, the blood swirls and sits in place because it's not pumping adequately and people can form blood clots in that top part of the heart, which unfortunately can be ejected from the heart and cause a stroke since the brain is the first stop out of the heart.

So in anybody who comes in with a stroke and we don't know what the cause is, they should be on heart monitors to make sure that they don't have atrial fibrillation. But generally speaking, you know, when people go for their yearly physicals and they're over the age of 40, an EKG is often a good idea to make sure that they're not in an abnormal heart rhythm and there isn't something in particular that we should be doing for it.

Caitlin Whyte: Just how life-threatening is AFib? You know, the example you gave us, "I'm sitting on the couch. I feel a little fluttery, maybe lightheaded." What should I do in that moment? Or how fast do I have to act?

Neel Khanna, MD, MPH: Well, it depends what the symptoms are. You know, obviously, some of the more high-risk symptoms that we see is that if you feel your heart racing and you're feeling lightheaded, that's a pretty high risk symptom, particularly if you faint. What that would probably mean is that your heart rate is going so fast that your heart is not filling with blood and oxygen and as a result you can faint. Also, if you're feeling the palpitations and chest pain at the same time, that's another sign that your heart rate may be going too fast for you.

But for people, you know, palpitations is not a very uncommon symptom for people who feel it intermittently. You know, it's a good idea for you to check in with your either regular primary care doctor or a cardiologist, if you have one, so that they can do certain tests like heart monitors to see, you know, when you're having those symptoms, are you in a normal rhythm or are you not?

In terms of whether AFib is life-threatening or not, in its immediate sense, it's not a life-threatening rhythm. It's not necessarily that you're going to go into atrial fibrillation and your heart is going to stop or something like that. We as physicians and heart doctors are more worried about the long-term risks of atrial fibrillation. One is, you know, if the heart rate is constantly going fast, you increase your risk that your heart can weaken as a result from going fast so frequently. That's one major risk.

Another major risk is because people just get winded more easily. So they'll notice that they're not as active as they used to be. And they may notice swelling in their legs and different, you know, signs and symptoms like that, just particularly because their heart is constantly working overtime and working faster than it should, so we start to see some of the signs of heart failure.

But in its truest form, atrial fibrillation, the biggest worry that it has for us as physicians treating it is the risk of stroke. And in certain patients, it can quadruple your risk of stroke in a yearly basis. And that's not something that the patient or the doctor would like to see. So in patients with the necessary risk factors who we have demonstrated have atrial fibrillation, they are often candidates for blood thinners that would take away their risk of stroke and really reduce it to the risk that the regular population has.

Caitlin Whyte: Gotcha. That kind of leads me into my next question again. I mean, if this happens, what kind of lifestyle changes happen to kind of prevent those long-term side effects you were talking about?

Neel Khanna, MD, MPH: Well, one is obviously medication in anybody with atrial fibrillation who have certain other risk factors. And we have a risk score called the CHA2DS2-VASc score, where it takes into account diabetes and hypertension and age. But if someone were to have some risk factors and have AFib, then like I said, they should be on a blood thinner because that will take away their risk of stroke.

Aside from that, obviously healthy eating is a clear predictor of heart disease. So staying away from stimulants, excessive caffeine or alcohol, for example. It's clear that the incidence of atrial fibrillation is higher in those people who suffer from alcohol abuse. So limiting some of the toxins like that will reduce your risk of atrial fibrillation.

Unfortunately in some patients, even if they live a totally healthy lifestyle, age is the biggest predictor of atrial fibrillation. And it's not uncommon for people who are otherwise healthy for once they get over the age of 60 for them to develop atrial fibrillation. And it's one of the leading risks and causes of stroke in that each group. So, you know, unfortunately, in some people, it happens as they age. In other people, it can really be either postponed or prevented with healthy lifestyle choices, staying away from alcohol, having regular exercise routines and seeing their doctor regularly to make sure that there aren't issues.

Caitlin Whyte: Great. Well, a lot of information here. Doctor, wrapping up, is there anything else you'd like us to know about AFib?

Neel Khanna, MD, MPH: Just that, like we said, it's not an immediately life-threatening diagnosis. It's not something that someone has to set into a panic if they've been diagnosed with it. But it's something that like other things in life need to be monitored and managed correctly to prevent major things from happening. So anybody who has symptoms that they are not used to, whether it be shortness of breath with exerting themselves or feeling their heart racing, it's a good idea for them to check in with their physician so that they can seek the necessary help and make sure that they don't have atrial fibrillation for example.

Caitlin Whyte: Well, we so appreciate your time, doctor. That was Dr. Neel Khanna, the Medical Director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall. Visit montefioreslc.org for more information about the Cardiovascular Institute. If you found this podcast helpful, please share it on your social channels and be sure to check out all the other Doc Talk episodes.

This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Caitlin Whyte. Stay well.