Atrial Fibrillation: New Solutions for an Old Problem

hello welcome to the ut health east texas virtual education series today's presentation topic is atrial fibrillation new solutions for an old problem featuring dr andrea cooley board certified cardiothoracic surgeon at ut health east texas cardiovascular institute hi there my name is dr cooley and today i'd like to talk to you about atrial fibrillation and we're going to talk about some new solutions to an old problem where everybody has pretty much heard of afib and so you're probably wondering why is the surgeon talking about afib of all the things i could talk about that are exciting and interesting afib doesn't seem to be the one that would typically pop into your mind so here's my answer afib is extremely common you may have a fib you probably know someone who has afib we see tv commercials all the time for the treatment of afib you hear people talk about it all the time so what does everyone usually say they say oh i had to deal with a little bit of afib or it's okay i just had a little episode of afib i got over it i got some medicines so not really a big deal for decades the medical profession has had that impression that afib is more of a nuisance it's not one of our major heart diseases it's not really a big deal we just kind of have to deal with it deal with the symptoms and make sure we don't have any major problems from it over the past few years we've realized that afib is actually a major problem it's a really big deal it's becoming more and more common and it has a lot bigger impact on our health than we really appreciated in the past because of this there has been research pouring into afib as far as what causes it how does it work why is it so tricky to try to control and correct and what are things we can do to try to stop afib besides the typical old things we always tried so that's what we're going to get into today finding out ways to fight afib through all the different stages so when i said afib is a is a big deal and it affects a lot of people here's what i mean afib affects in the u.s about 6.1 million patients today we put this in perspective by understanding that all cancers combined aren't even this this big number so afib is affecting more patients than cancer does in the next 25 years we're expecting this number to double so it's becoming an accelerated problem in our in our population right now about nine percent of people over the age of 65 are walking around with afib that's almost one out of every 10 people when we're looking forward to the next generation so people who will be 65 in 20 25 years so my crowd 40 year olds right now we actually expect it to be one out of every four people will have afib so we realize we need to stop this problem now as it's accelerating we need to put put some brakes on it currently the us spends about 26 billion dollars a year on the treatment for afib and as we all are very aware of health care costs right now you can see why that is a big deal so trying to stop this is important from that standpoint but also really how patients do so if again if it's just something that's a nuisance and yeah a lot of people have it well you know a lot of people sprain their ankles too we wouldn't think it was that big of a deal but we know now that afib patients who have that actually have a five times higher risk of stroke their risk of having heart failure is three times higher and their risk of dying from an early cardiac death is actually two times higher so very significant around 2014 and 2015 some new research started coming out and they showed several studies looking at people who had afib for the first time and it was bad enough they had to get put in the hospital to try to control it try to make their symptoms better and try to get that fast heart rate under control so they looked at these people for about five years to see how they did and really shockingly they they did not do as well as we thought they typically should so they had high rates of heart failure they had high rates of strokes heart attacks they had bleeding problems like gi bleeds from having to be on blood thinners for afib but most frighteningly about 50 percent almost so 48.8 percent of these patients actually passed away within five years of that first admission for afib so this really caught the attention of people in the medical profession to say wait a minute this is a big deal we really need to look at this more closely so this is why all this research started interestingly afib is a uniquely american disease so it's not to say it doesn't happen in other countries other regions of the world but it is two to three times higher in the u.s and we can thank our american lifestyle our diet our activity our other medical problems we have for that really big boost in afib so this is compared to similar developed countries countries throughout europe were much higher than them but it's also even comparing it to developing nations so nations in africa south america they're doing much better than we are on afib you can see from this map as i'm sure we're used to actually looking at similar maps right now with covet of you know darker colors means it's more severe if you look into our little east texas zone here you can see that east texas has some of the highest hospitalization rates for afib in the country so especially in our area we need to take this very seriously and luckily we have some new options to really get after this and take care of people so in order to talk about afib and what it does to the heart we need to understand what's normal for the heart and i'm a surgeon so of course i'm going to talk about anatomy because it's one of my favorite things so when you're looking at the heart we want to think about it from left to right and from top to bottom so when we're thinking about left to right we're talking about what side of the heart pumps to where so our right side of the heart gets all of our old blood that's used up all the oxygen has been used by ourselves we get that back to our from our body to the right side the right side then squeezes it into our lungs the lungs put oxygen in and then it goes into the left side which can then squeeze it out to our body so it's just a loop just keeps doing that circuit over and over when we're talking about top to bottom that's when we talk about there are two types of heart chambers so there's an atrium and there's a ventricle an atrium is a collecting chamber so that's where blood comes in collects before it goes to the ventricle so you can think about that like a regular building when you walk in from outside into an atrium you're coming from outside in you have a bunch of people collecting and waiting for to go on to their destination exactly like an atrium in the heart once it goes through the heart valve into the ventricle that's when the ventricle can squeeze hard and get it out to its destination now when we think of that heartbeat we think of that typical sound lub dub lub dub lub dub that's our two our top and our bottom squeezing so lub atrium dub ventricle lub dub lub dub okay so they do it in order like that now your heart has its own pacemaker system and that's some nerves within within the heart that act like an electrical circuit so we have our own natural one of course we've all heard of pacemakers where we put in an artificial one if yours isn't working but your natural pacemaker starts at the top of your atrium on the very top of your heart the job of the pacemaker is to control your heartbeat so how fast your heart beats your pulse and it also controls the heart rhythm which is the pattern your heart goes in so we want to make sure our goal is to have it nice and a regular pattern just like a ticking clock and make sure everything's nice and coordinated because that's very efficient for your heart we have thousands and millions of heartbeats to have in our lives so we want to make sure that every heartbeat is as efficient as possible so that heart can last as long as possible now just like regular electrical engineering this is a circuit so the electrical signal starts it passes through the muscle which is conductive so the muscle tissues pass it along and it moves through the heart and then it goes in the circuit and repeats the very beginning of that circuit starts like i said at the top of the heart something called the sinus node that's why when we have a regular heart rhythm we call it a normal sinus rhythm so you may hear that phrase if you've been dealing with afib your doctor may say oh we're in a sinus rhythm that's what our goal is that's normal so as it starts going through we have the sinus rhythm starts it sends it down the atrium and then it hits this new spot in the heart called the av node and that's when it gets to the ventricle and it catapults it around the ventricle to cause a good heart squeeze okay so love dub lub dub that's what we're working on the way i think about how it works with a coordination is if you're at a stadium and you see people doing the wave everybody's waiting for their turn the signal starts here and the crowd goes stands up goes all the way through and then it goes around and starts again that's exactly how our conduction works so we call that in medicine we call it a wave propagation okay so we're moving that wave of electricity through the heart and watching that heart contract if you think of movies you've seen where someone's walking up to an electrical fence what happens when they touch it they grab it right so that electricity makes muscles contract so that's exactly what happens as it's going through the heart so that's normal that's our normal sinus rhythm then let's talk about what happens in a fib so afib the a stands for atrium so atrial and fibrillation means wiggle so when you have afib there's a cluster of cells somewhere in that atrium that decides to go haywire for whatever reason okay so we have our normal signal that's supposed to come from the top of the heart but then we have this little renegade signal somewhere else that starts sending out impulses so as these waves start propagating and these waves start propagating they start running into each other so things get very chaotic they aren't coordinated anymore and instead of squeezing it just wiggles okay when you think of kind of what a wiggle would be think of that really annoying twitch you can get in your eyelid when you're tired that is one little cell one little area just going bad going renegade and going haywire and having its own twitch so it's twitching away but it's not doing anything to help you actually blink your eye okay so that eye blink is should be our normal regular contraction but that that twitch is the fibrillation that wiggle once you have that afib that's what counts as being an afib even if you can't feel it okay and that's where we start getting our our complications another thing that you may hear about is something called a rapid ventricular response and this is typically what people think of when they think of afib that they have this really fast really irregular heart rate that is true but that is part of afib so as these signals are swirling around the atrium if one of them happens to swing by and hit that av node that we talked about that catapults the signal around the ventricle it does just that that av node is not very smart so anytime a signal goes by whether it's a good signal a bad signal it just reacts so it'll catapult catapult catapult and just keep doing it around and around and around so you get this very fast heart rate very uncomfortable and that's typically when people feel their symptoms when it's going fast but that's one of the very important things that we understand as of the last few years even if we're not in that rapid response you can still be an afib and still get the complications even when you can't feel it so that will be important soon so when we're thinking again of what fibrillation is like i like to think of it instead of that nice wave we're thinking of a boiling pot of water so it's bubble bubble moving all over like that all right so now that we've talked about what afib is let's talk about why and what happens in your heart and why is it so hard to control so we're going to talk about pathophysiology big medical word so pathology means a disease state and physiology is how something works in your body so when we talk about pathophysiology it's when something disease-wise is not working right in your body so there are a lot of reasons afib can come around a lot of reasons that it can be very hard to treat and very hard to to go away we call it refractory meaning it's just very pesky basically all these reasons circle around the fact that afib can make scar develop in your heart and that disrupts the circuit so like i was saying muscle conducts electricity scarred is not so when you have scar tissue it's not muscle it can't squeeze it can't conduct electricity it's just like a bar of of cement that sits there so that can disrupt our normal circuit of how things are supposed to be coordinated through the heart it has to figure out how to reroute around it sometimes that signal runs right into scar if it's big it can't go anywhere so it kills the signal that lets other bad signals have time to take a foothold other conditions that make your heart work harder like hyperthyroidism sleep apnea obesity that all gets your heart ramped up it can make your heart stretch some same thing with heart failure valve disease that makes your heart stretch out and enlarge all of these things can stretch out that electrical circuit and make it so then the conduction pathway gets messed up okay so it becomes very unpredictable and then as that scar gets worse the stretching gets worse that makes our conduction worse which then makes the scar worse makes the stretching worse and it just becomes a really bad cycle that can be very difficult to fix now as of the last few years we've we've come up with a better understanding of what's happening in the heart and luckily come up with ways to treat your afib based on what part is happening in your heart so early on with afib we know from some very very fancy mapping that electrophysiologists can do and that's a specialized type of cardiologist that deals with the electrical system of the heart we know that when you first get afib it usually comes and goes comes and goes and that's called paroxysmal okay so it's our early intermittent kind of afib and that almost always starts as that little cluster of bad cells and they're sitting one spot in the heart and they just go off like a little strobe light or morse code going off in there and they send out their signals and they turn off and they turn on but it comes from one spot so that spot is typically from the studies they've done sitting right on the back of the left side of your atrium where your veins from your lungs come in so that comes in handy when we're talking about how we can fix this now around the six-month mark of having a-fib if we can't get it knocked out in that early phase which is the best chance we have to get rid of it things start to change so like we just talked about we have scar tissue we have stretching and a lot of times that isn't always reversible so as that starts changing that conduction pathway gets messed up and it goes from having those little signals that are coming out from one spot to something new called a rotor and that's more like a tornado that's swirling around and around the heart so it can just whip up out of nowhere it can start here but then it's moving so it's hard for us to catch when we're trying to fix it we can fix one or we we try to zap it here but by then it's over here or a new one can start so it's just like a tornado and just like a tornado it's chaos just goes all around that atrium that is called non-paroxysmal or prolonged day fib and that's where a lot of our new treatments are coming in because that's the people who really have a hard time with symptoms start having all these changes to their heart and just really have a hard time getting it fixed with our normal ways we've always used so looking at symptoms how do you know if you're in afib how do you know you have it typically you're going to have palpitations heart racing heart pounding that's that typical symptom but like we were talking about earlier that happens when that ventricle gets going really fast so that's when people notice oh man i'm having an episode of afib people can be an afib and not feel it and that is being their heart rate is still not over a hundred but it's still in their wiggling just the top part of their hearts wiggling so that happens in about 15 percent of cases of new cases we just happen to see it on monitoring because we hooked you up to an ekg for some reason so that's what makes afib so dangerous is you can't always tell you're in it other things that can happen is that heart sitting that atrium's wiggling it's not helping pump blood forward okay so that's what we call an atrial kick it's like our our turbo boost on a race car we push that and it kicks blood forward so the ventricle can push it out more when we lose that we lose that efficiency of the heart and that can actually take down the efficiency of your heart by about 20 percent in some people they can be very sensitive to it as that heart is holding that blood where it's not pumping forward again it starts blowing it up like a balloon so it starts stretching fluid starts backing up and that's where we get our complications when we have that that's when people have problems getting dizzy they get short of breath because that pressure backs up on their lungs their blood pressure can get low and then also they can just feel really fatigued so going on to the complications besides just what it makes you feel let's talk about what we all think of with afib when you see a commercial what's the commercial about it's not about your heart rate going fast or our conduction pathways it's about blood clots and it's about strokes we know afib is responsible for one out of every five strokes in the u.s so it's a huge huge problem so it's appropriate that we should be really focused so how does it happen why does afib cause strokes so when that blood is just sitting there and it's kind of pooling in the in the atrium because it can't squeeze it forward as fast it can cause a clot so think of when you get a scrape on your arm what happens if you don't wipe that blood away it forms a scab right clots forms a scap the exact same thing happens in your heart you have a lot of nooks and crannies inside your heart typically there's one spot off the back of your heart called your atrial appendage where most about 95 of these clots form but we know that can be the major problem unfortunately these little clots can break free and then they can go in your regular circulation typically the first spot that it your first stop is up to your brain it can clog things up and cause a stroke so the next thing that can happen though that doesn't get nearly as much press as strokes is problems with your heart valves and heart failure so as that blood is staying in that atrium and it's wiggling around the heart starts stretching well the heart valves are sitting in the middle of your heart to make sure blood's only pumping forward they're like a turnstile at a train station blood should be able to go through but it can't go back well as that that valve starts stretching stretching stretching it can't close all the way anymore so blood starts leaking back what does that cause more stretching what does that cause more afib so it just turns into a bad cycle the longer you have the stretching the scar tissue now it's accelerated by a valve problem then we get into heart failure and that's where your heart's been working it's not efficient and it gives everything it can but eventually the muscle itself starts getting tired your whole heart starts at larging and that's when we start getting into problems that may not be reversible on the strength of your heart so that's why afib can have a big impact on heart failure so those are the big scary things that afib can cause okay so let's talk about how we can help now okay so the the good stuff so typically when we're talking about afib treatment we're going to talk about in two pieces one preventing strokes like we know that is a huge problem with afib so that's its own treatment on itself regardless of what we do with trying to fix the heart and slow it down we want to prevent those strokes so part number two though is trying to get that heart back to normal okay and that normal sinus rhythm ideally or at least making it so it's slowed down so you're not getting the effects as bad or you're not having as much as many symptoms so talking about our our stroke issue the first the treatment nearly everybody is on is anticoagulation which means blood better medication typically we start out in the past it was something coumadin warfarin there are a lot more different medications now that are relatively new they are not as finicky you don't have to check levels all the time things like eliquis is typically our first one we try there's different types though so if you're not on eliquis as long as you're on a blood thinner it doesn't mean it's wrong it's just you know not the most common one but your your cardiologist likely has a good reason why they picked that one a lot of times people ask hey i'm on an aspirin is that enough unfortunately it's not enough in this circumstance and aspirin only takes care of your platelet cells that start clots but we need to really thin out that blood to prevent that stroke so unfortunately aspirin usually is not enough the reason why people have to stay on this medication like we talked about is sometimes you don't know when you're an afib so you may think up you know what i've been feeling better we got it under control i should be able to come off my blood thinners since we sometimes can't tell when we're in it or it's still in there wiggling even though we're not getting that rapid heart rate we still need to stay on it because some studies have shown that clots can form in your heart within five minutes of being an afib so it's very important on that now blood thinner medications are very strong so we can have problems especially as we get older and this is a disease related to age as we get older we can have problems with gi bleeding we can have problems ulcers we can have problems if you fall and hit your head you're gonna have bleeding nose bleeds all those type of things so some people just cannot tolerate being on a blood thinner and there are some special risk calculators that your doctor could look at to decide okay is your risk too high or are you okay and how do we decide that so if you are one of those people that cannot be on a blood thinner then we actually have some new technology to help with that so if you remember back when i was talking about the nooks and crannies inside your heart there's an area right on the back called the atrial appendage and it's kind of like an appendix it's a part of your body it's there you don't really need it but it can cause problems okay so basically it's like it looks like a little finger and it's hollow so blood can get in but it has a hard time squeezing back out so it can kind of sit there a little more than other areas of your heart and we know when blood sits there it's going to form a clot okay so when we have that we have two options that luckily are both available here at ut one is called a watchman device and that's when that electrophysiologist goes in in your groin and he can go up through your heart and put this little plug over into the atrial appendage so blood can't get in there to form a clot so we don't worry about that as much anymore the other option we have is with me if i'm doing some kind of surgery it's something called an atra clip and it's kind of like a clip that you put on a bag of chips i can put that on the outside of your heart if i'm in your chest for some reason and it pinches it off almost like when babies have their umbilical cord clamped off same thing it pinches it off blood can't get in the area of your heart just shrivels up and turns to scar we leave that thing in there it's outside of your heart it's outside your bloodstream we don't have infection problems so it's pretty straightforward thing to put in if i'm already in your chest that's the key the next thing we look at you know when we're done with okay we've worked on strokes let's work on getting that heart better okay the first thing a lot of people try is something called rate control and this is really pretty typical that this is what people are going to go with and it's medication like beta blockers calcium channel blockers are the typical ones and that's to make it so that heart will not go fast as that afib is happening and it zips by that that ventricle we don't want it to react so that really helps bring our symptoms down what we are getting a better understanding on right now is that still doesn't take away afib it just takes away the symptoms so you can still get some of the complications so if you're on rate control you always are on on blood thinner with it but the studies right now are going saying oh do we need to try to push people into a normal sinus rhythm some studies way in the past said well you know what survival isn't any different and when we started really teasing through it knowing the strokes knowing the heart failure knowing the valve problems that afib can cause there's thought that the reason the studies didn't show any difference is because sometimes the side effects of the medicines to put you in a normal sinus rhythm can be so bad they kind of get rid of that benefit for us so that's when we're going to talk about some of these new treatments so if we're trying to get you back into a regular sinus rhythm so completely get rid of that afib the first thing we will try is medication so typically amiodarone sometimes you'll hear things like digoxin ticus and some specialized medicines they work really well for a lot of people unfortunately a lot of times though if that efib keeps coming back staying on these medicines can make some people feel pretty lousy so that's when we start thinking of moving on either if you can't handle the medication itself from side effects or we're seeing it affect your liver or you know some of the labs we check for surveillance or if you're still having symptoms and it's just not working then we start moving on to things that are a little bit more aggressive the next thing i'm sure you've heard of is something called a cardioversion so we shock your heart back into rhythm so the way that works is your heart that pacemaker actually has a mind of its own so your brain does not control the pacemaker on your heart and a good example of this is when i was in dallas and doing heart transplants we would cut out a heart that was all no good and we're going to get ready to just send it in the lab and it would sit on the back table and it can sit there and beat by itself until it runs out of oxygen and then we take this new heart that's been sitting in ice for four hours and we put it in we don't have to do anything to shock it back on we just give it blood supply and on it comes so the heart wants to beat that's his job that's that's paid that pacemaker's job so that's what we count on when we're shocking your heart back into rhythm it's like unplugging an alarm clock and plugging it back in or setting a reset button so you get some sedation you get some special stickers put on you and they conduct electricity and it gives you a quick shock makes everything reset and then lets your heart's pacemaker kick back on this can be very successful it can work really well but sometimes if you already have that pesky form of afib that prolonged afib with the changes in your heart sometimes this doesn't last so it can be you know sometimes it works for a day sometimes it works for a week um if you have an early kind sometimes it works for good or you know five years you might need it again that's great but these people who are really refractory where it just you know we'd have to shock you and then do it again in a week and do it again in a week we need something better and luckily we've come up with it so the next thing that we move on to if you're still having symptoms is something called an ablation and there's three different types of ablations we're going to talk about here first one is with my colleagues again the electrophysiologists and what an ablation is is where we go in either and we're forming scar tissue so remember in the beginning we're saying scar tissue is bad it doesn't conduct electricity it makes everything get stretched out and distorted and that conduction system isn't working right well we've decided that we can try to use that scar tissue to our advantage if we put it in the right spots so we build a wall of scar and that makes it so these signals can't pass through them we're basically walling them off like they're in jail okay so when we talked earlier about that early afib where it comes and goes that paroxysmal kind we know that the vast majority of people it starts right in the back of the heart by those pulmonary veins so the the electrophysiologists can again go through your groin go up into your heart and they can find those little areas those veins easy for them to see because they're big and they just go in and zap zap zap zap almost like burning off a wart or freezing off a wart and they build that scar tissue wall all the way around those veins so those signals can't come into the heart at all it just stops them okay now like i said this is really good for that early kind of afib they have about 90 percent success long term of that afib not coming back if we catch it early enough the next thing we have is surgical ablation so that's when i come in when afib really gets going and we have those rotors and those tornadoes are coming all over they've gotten out of those pulmonary veins so just doing that one area we might have it pop up somewhere else or move and things like that so when i'm in open heart surgery i can do something that's called a maze and that's where i take this clamp which burns and i also have a probe that freezes and i literally draw a maze on the heart i do 13 different burn or freeze lines and that makes it so the signal from that sinus node has to run through my maze and get to that av node to go through the ventricle but all those other tornadoes and signals get lost in the maze run into the walls and stop okay so the maze it's actually the surgery has been around since the mid 80s we've really refined the technology on it but that has even for those really refractory those really tough cases that has about 85 90 percent success okay if we're talking about those really tough cases um if we're trying to do it through the groin with that other ablation nationally it's about anywhere from 30 to 50 success long-term because all the scar tissue and those rotors that are still floating around everywhere so it works some but it's you know we're like oh we can do better than that so you know when we look at this we say okay so this maze will work for the early kind it'll work for the bad kind we've found our answer that's great except for the fact it requires open heart surgery and only about three percent of people who have afib need open heart surgery as well so that is a lot to go through to have a surgical ablation to have open heart surgery on the heart lung machine staying in the hospital for a week all those things so again we thought we could do better and we've come up with something so there's something now called a hybrid maze that we are rolling out here at ut and that's where my colleagues the electrophysiologists we take the best of their world we take the best of my world and put them together to do a minimally invasive ablation that gets nearly the same results as that big open surgery okay so this is for people that have that that refractory disease you've had it for a while maybe some of the other things you've tried haven't worked okay so this is the next step so what we do is we have um you come in and it's a two-stage surgery where you come in with me and we take you to the operating room i don't have to put you on the heart-lung machine i don't have to open your chest i make a little incision underneath your breastbone and i have this special camera that can go up up behind your heart and a special catheter that's called a radio frequency ablation but basically it burns the very back of your heart so i'm looking directly at your heart it's still beating on its own and i go in there and i do that ablation all along the back wall of your heart so the goal is to have it so those rotors can't form okay and it's not going to conduct any of the electricity through that zone of your heart is not your normal pathway so we're not going to mess our maze up okay your a point a can still get to point b and that'll be fine so after we do this we leave a little drain in place close it up all the stitches are underneath your skin and we keep you in the hospital usually for a day or two make sure your heart's behaving check an echocardiogram do some typical some typical studies that we do in the meantime between my surgery and the next stage we still have you on all your medicines you can still go into afib because we're not done yet the second stage you come in with the electrophysiologist as an outpatient you're going to end up going home the same day he goes up your groin through to your heart and he can finish on the inside of the heart the stuff i couldn't reach from the outside of the heart okay so typically if it's that surgical ablation the big one i can get to all parts of your heart because i'm in there with my bare hands and it's open heart surgery and i have you on the heart lung machine i can't do that unless i have you on the heart lung machine but they can get to the inside parts so they go through and they finish all those walls for me okay so that's what our what our convergent procedure is called that's a hybrid ablation um typically like i said the results are in the 70s up to 80 85 percent success in some people of getting rid of that afib for good and that's completely getting rid of it and we're talking about afib even getting the amount you're in how bad you feel the medications you have to be on getting those down is immensely helpful so all the studies are going on about that now to even see the benefits from that so the biggest question is of all these treatments i've talked about which one's right for you that all depends on you so it will depend on how bad your afib is how long have you had it how bad of your symptoms been what else have we tried already and we start low with medicines and we start building up depending on what you need so basically anybody who has symptoms and they've tried some of the other things and they're not working they would be a candidate for the hybrid ablation [Music] first question is can you take a decongestant when you have afib answer is yes you can so decongestants in general can make your blood pressure a little higher any medicine that you have that has the dash d claritin d allegra d those things can just make your blood pressure a little higher makes your heart have to work a little bit harder if you have very very difficult afib to control your cardiologist may recommend you know what you need to stop things that'll kind of ramp up your heart but in general that's not going to be the thing that's really causing your afib similar things that we run into if people are really sensitive or their bodies under some other kind of stress really any stress in your body will kick that afib up things like inhalers can kick it up they're not causing the afib but if you're already not feeling good they can ramp it up so we watch for different things caffeine alcohol can that's another question we actually got can i drink alcohol with afib you can i'm a big everything in moderation kind of person but if your body proves to you that you're really sensitive to it then you need to back off of it alcohol itself again won't cause afib but if you drink a lot if you drink daily it's going to make your heart work harder so alcohol itself can make your heart have some problems where it enlarges a bit and that the enlargement is causing the afib the higher pressures inside your heart are causing the afib so alcohol can flare it up it can make it worse so again i'm not saying no you could never have wine or a celebration drink things like that but you will want to be careful not to do it in excess okay another question we have is how do i monitor my afib if i cannot tell when it's out of rhythm and that's a great question and that's that's part of the problem with afib is you certainly can be in it and not feel it typically we just treat you like you're in it if you have it that's why we treat you with those blood thinners to protect you so we don't have to worry even you know like oh maybe you had it and we don't have you protected from a stroke we're going to protect you regardless okay other things you can do again given technology as it's moving forward there are some very good wearables right our watches can show us our heart rate a lot of times blood pressure cuffs you may have at home they'll detect heart rate and even give you an alert if you might be an afib there are some really good ekg monitors one is called that actually my cardiologist recommended to me is called cardia it's k-a-r-d-i-a and that's just something you can get at best buy it links with your phone and you can do an ekg and it can help you and you can even send the result to your cardiologist um so those things are helpful but they are not necessary so that's why we're going to treat you like you're in it to keep you safe another thing that people ask is ways to stay safe try to get rid of their afib or prevent big prevention so like i said afib is really rampant in the united states because of our lifestyle so if we try to get out of our routines and our typical lifestyle things of fast food processed food high blood sugars being overweight being not very active those things definitely help there are some studies showing the mediterranean diet so non-processed foods fish good oils good fats all of those things are probably the most helpful from an afib standpoint but really any time you're eating a healthy well-rounded diet and trying to stay with the fresh stuff and get away from the process stuff that's going to help your heart in general it will also help afib one of my favorite things to tell people is there's actually a study that shows if you eat dark chocolate one time a week your rate of afib drops by 16 percent so i highly recommend everyone eating dark chocolate at least once a week unfortunately the study showed there was not an extra benefit if you ate it every day we hope you enjoyed the presentation today for more information about scheduling an appointment with dr cooley call 903 595-6680 or visit uthealthestexasdoctors.com our next virtual seminar will be announced soon follow us on facebook to stay up to date on upcoming events and seminars thank you for watching

Channel: UT Health East Texas

Views: 2,157,914

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Id: 1-SWiGsBYqw

Length: 38min 36sec (2316 seconds)

Published: Mon Mar 01 2021