Joey Wahler (Host):
If your heartbeat feels irregular, you may be suffering from atrial
fibrillation, which if unaddressed, could lead to a life-threatening condition.
So, we're discussing the causes of AFib and its treatment. Our guest, Dr. Neel
Khanna, a cardiologist and Medical Director of the Cardiovascular Institute at
Montefiore St. Luke's Cornwall.

Host: This is Doc Talk, a podcast presented by
Montefiore St. Luke's Cornwall. Thanks for listening. I'm Joey Wahler. Hi, Dr.
Khanna. Thanks for joining us.

Neel Khanna, MD: No problem. Happy to be here.

Host: Happy to have you. So first, how common is atrial
fibrillation in the first place?

Neel Khanna, MD: It's much more common than people would
imagine. Number one, there are many people and more studies are sort of
bringing this out, that there are many people who have undiagnosed atrial
fibrillation, meaning they have atrial fibrillation, which is called
paroxysmal, meaning it comes and goes, and they may not know during the periods
that they're having it, that they actually do have it. As we get older, our
risk increases significantly of having atrial fibrillation. And over the age of
80, there's a good segment of the population, some studies say up to 20-30%,
which display evidence of atrial fibrillation.

Host: Wow. Okay. I'm going to ask you about those causes
and who's most at risk in a moment. First, what exactly constitutes an
irregular heartbeat in terms of how it compares with a "normal beat"?

Neel Khanna, MD: So, often people, and I see patients
who come with this, take their pulse reading, and that could be as simple as
putting your finger over your carotid pulse in the neck or radial pulse in the
wrist, or now people increasingly have Fitbits and Apple Watches that kind of
tell them that their heartbeat is irregular.

Generally speaking, when you feel your pulse or your heart
rhythm, it should come at regular intervals. It should feel rhythmic. You
should not feel pauses. But there are many causes of why your heartbeat may be
irregular, or you may feel certain pauses when your heartbeats, one of those
causes is atrial fibrillation. The vast majority of the causes are not
problematic. But of course, atrial fibrillation is problematic.

Host: So, how do you determine whether that is the
cause?

Neel Khanna, MD: Basically, and as I mentioned, this is
changing now as people have more kind of observation devices such as Apple
watches that have a special EKG algorithm on it, or there's a new product
called Kardia, which also can monitor your heart rhythm. Those can tell you if you
have rhythms that are suspicious for AFib. But the hallmark is going and seeing
a doctor and getting an EKG. If you feel unwell or you feel your heart is
racing, or you feel like your heart is irregular, it's a good idea for you to
either see your primary medical doctor or to go to an urgent care if you have
significant symptoms or see cardiologists so that they can do an EKG. An EKG
will be diagnostic if you're having symptoms at that time, it will be
diagnostic of atrial fibrillation.

Host: So to be clear, these devices that people now
have, watches and such where they can do their own check, I guess what you're
saying, am I right, is that's fine, but it's not the be-all end-all. A
specialist still has the final word, of course.

Neel Khanna, MD: It's just, if you're suspicious, it's
to kind of point you in that direction. They're almost screening tools. But to
have a true diagnosis, you must have an EKG. Obviously, we would never give a
diagnosis just based on a reading on an Apple Watch, for example. But if you're
concerned and you have symptoms, it's something that your physician can review
and then try to catch on our EKG to give a true diagnosis of something like
atrial fibrillation or any abnormal heart rhythm that we would term an
arrhythmia.

Host: Gotcha. So, what are those typical causes of AFib?
Who's normally most at risk?

Neel Khanna, MD: There are commonly known risk factors
for atrial fibrillation. One is excessive alcohol use. Another is obesity and
sleep apnea, both put pressure on the heart, sometimes on the right side of the
heart and make it more likely for you to have atrial fibrillation. Also, people
with valvular issues, there's a valve in the heart called the mitral valve.
Mitral valves, which happen to be significantly leaky or have regurgitation,
tend to lead to atrial fibrillation in many of the patients. But the truth of
the matter is, in most cases, it's an age-related disease, meaning as you get
older, you become more apt as your atrial becomes scarred with age, to develop
these abnormal rhythms like atrial fibrillation. Atrial fibrillation basically
is an erratic firing of the signals in your left atrium where your heart rate
is no longer regular and controlled, instead it's firing erratically and it
tends to happen in people as they get older. The risk of it increases
dramatically after the age of 65.

Host: So, what are some symptoms of an irregular
heartbeat, readings and screenings on your own aside, that patients may notice
themselves?

Neel Khanna, MD: If you're feeling your heartbeat
consistently, and specifically if you feel your heart rate going very rapid and
it's associated with dizziness or shortness of breath or chest pain, it's
suspicious for an arrhythmia, or also called an abnormal heartbeat. And those
are the type of symptoms that you should get evaluated by at least your primary
care doctor or maybe a cardiologist.

But primarily, the symptoms of AFib happen to be palpitations,
just a feeling of your heart racing. Because often, atrial fibrillation does go
very rapid. But if you have that associated with other symptoms, like I
mentioned, of shortness of breath, swelling in your legs, it could be a sign
that you're having atrial fibrillation consistently, and it's causing your
heart now dysfunction because of that.

Host: Now, we'll talk about treatment options in a
moment. But as mentioned earlier, if left untreated AFib can cause
life-threatening conditions, right? What are those?

Neel Khanna, MD: There's really two major risks with
atrial fibrillation. One is more symptom-based, meaning if atrial fibrillation,
like I mentioned, tends to be erratic and be very rapid, meaning normally the
normal human heartbeat ranges from 60 to 80 beats per minute. People in atrial
fibrillation that are untreated, especially if they're younger, tend to have
heart beats or heart rates in excess of 110, sometimes 120, 130. There are
people who go all the way up to the 180s and 190s and feel consistently unwell.
So when your heartbeat is consistently elevated like that, there's a strong risk
that, number one, you could feel dizzy or faint, or number two, that it could
slowly cause your heart to dilate and weaken. And so, atrial fibrillation is
very rapid for a long period of time, and is suboptimally controlled, can cause
heart failure by causing the heart to dilate and causing the heart to weaken
slowly from this chronic, fast heartbeat that atrial fibrillation can cause.

The second major risk of atrial fibrillation, which is probably
the biggest problem, is that because the atria or the top chamber of the heart
is not contracting like it normally does, it's fibrillating or sort of
quivering, the blood does not flow out of it evenly. And so, blood can swirl in
this top chamber of the heart. And when blood in the body is static or just
swirling, it can clot. And so, as we get older and with certain risk factors,
the blood tends to clot more easily. And so, it's a major risk of stroke.
Because once you have a clot in the heart, it can be ejected out of the heart
and the first stop is often the brain. And so, people with atrial fibrillation
are at significantly increased risk of having a stroke depending on what their
other risk factors are.

Host: So, heart failure or possibly stroke. So, what
AFib treatments are available and what's the most common of those?

Neel Khanna, MD: Well, it depends on what your risk
factors are. Often when people are older and have multiple comorbidities, we
tend to tackle those two major issues, meaning we don't necessarily get them
out of their atrial fibrillation. We may allow them to continue in that
abnormal rhythm, but we may just control their heart rate with special
medications that slow the heart rate.

Additionally, we may recommend often that the patient starts a
blood thinner. And these blood thinners, you may have heard some called Xarelto
or Eliquis or, most notably, one of the older ones, which is called Coumadin or
Warfarin, they thin the blood and they prevent that clot formation within the
left atrium. So, that's incredibly important. Often for younger patients who
are more symptomatic or if they developed any heart failure symptoms, we will
try to get them out of atrial fibrillation totally. And one of the ways we can
do that is by doing something called a cardioversion, where we put the patient
to sleep electively, and we shock their heart into a normal rhythm again.

But in 2023, we have multiple treatment modalities. One of them
is actually a cardiac ablation where we can send catheters up to the heart,
naturally cauterize or get rid of the areas where atrial fibrillation come
from. So, it depends on your risk factors. Some patients, we may elect to get
them out of atrial fibrillation into a normal rhythm again, and some patients
we may not want to go towards procedural treatments, but rather just control their
heart rate with medications and thin their blood to take away that stroke risk.

Host: Couple of other things. So, you mentioned EKG
earlier. How often should the average person have their heart checked and what
should that include? Just an EKG or anything else?

Neel Khanna, MD: Again, a lot of cardiology is
symptom-based. So, definitely anybody who has some cardiac symptoms should be
regularly monitored, sometimes every six months, for example. But, again, risk
factors are key in this. So if someone is over the age of 65, I often recommend
that patients get yearly EKGs if they're relatively asymptomatic.

But the hallmark of this is that if you do develop any
symptoms, chest pain, shortness of breath, palpitations, you need to get an
EKG. As soon as possible because that may tell that there's an underlying issue
that's going on that may require much more frequent treatment. There are people
who have atrial fibrillation or significant heart failure who are monitored
once a month and get regular followup with EKG readings that frequently.

Host: And so in summary here, doctor, what's your
overall message for those listening with an irregular heartbeat regarding their
potential prognosis once treated?

Neel Khanna, MD: Overall, what I would say is that if
you have symptoms, you should get screened because atrial fibrillation can be
very problematic if left untreated. The good thing about atrial fibrillation or
any abnormal heart rhythm or heart condition is that often, if you do get
screened and you do get discovered to have this condition, with treatment, your
prognosis can be just as good as if you did not have the condition in the first
place. So for patients who have irregular heartbeats, picking up atrial
fibrillation can potentially prevent a stroke, which could be a truly
life-altering discovery.

Host: Well, folks, we trust you are now more familiar
with what causes AFib and how it's treated. Dr. Neel Khanna, thanks so much
again.

Neel Khanna, MD: Thank you for having me.

Host: And for more information about the Cardiovascular
Institute, please do visit montefioreslc.org. Again, that's montefioreslc.org.
Now, if you found this podcast helpful, please share it on your social media.
And thanks again for listening to Doc Talk, a podcast presented by Montefiore
St. Luke's Cornwall. Hoping your health is good health. I'm Joey Wahler.