What Is Atrial Fibrillation (A Fib)? Everything You Need To Know

[Music] welcome to another episode of talking with docs i'm dr paul zalzel i'm dr brad weaning and i'm mike heffernan dr heffernan a cardiologist he's been on our show before and we really appreciate everything you teach us thank you so much for coming back again today and uh what are you going to be teaching us about today well we had a texting exchange a couple days ago and uh so i think it's going to be atrial fibrillation okay so you got a little bit behind the scenes look there about how we produce these shows texting back and forth yeah it's like four texts it's like hey could you talk about afib so what actually is atrial fibrillation um so let's let's start with what's normal okay um and if i remember i'm going to give you a diagram okay okay yeah so here's so uh here's a diagram so normal um so we all have a pacemaker at the top of the heart we're born with that pacemaker and it's essentially the quarterback so it's throwing the same play over and over and over again it sends electricity down to the center of the heart the electricity then branches off and goes to the two main pumping chambers below and that electricity tells the chamber okay beat fire okay so that that quarterback is the sinus sinus node okay we can see that here on the diagram not my holmes or tom brady anymore okay okay so that's normal um the problem with atrial fibrillation is that a whole bunch of rogue pacemakers have taken over and they totally ignore that quarterback and they're all starting to just throw the ball at random each of them so you can imagine hundreds and hundreds of balls all getting thrown at the same time it's really irregular it's really disruptive and the poor bottom chamber the heart has to respond to whatever it's being told to do and so it responds to each one and so it fires away now fortunately there's a little bit of a filter there you know we kind of the maximum heart rate for for atrial fibrillation somewhere about 150 180 beats a minute fortunately it doesn't go as fast as three or four hundred beats a minute which is how fast the balls are going up top okay so we have a filter that protects us okay so normal harvey would be about 70 beats per minute now this top end of atrial fibrillation is going to be about 150 beats per minute right which still isn't an ideal way to no let's walk around and live all right i think what's an important thing for people to know is that our heart is two sides so the right side of the heart pumps blood from the rest of your body to your lungs and then it goes from your lungs to the left side of your heart and then your left side of the heart pushes it out through the body so our most are we mostly talking about the left side of the heart or the right side of the heart mic or both we're actually talking about both yes um so the pacemaker is actually located in the upper right chamber but the electricity runs down so that it synchronizes the beating of of both bottom chambers right and the other upper chamber as well so they're all interconnected and it's really uh you know it's a beautiful piece of hardware okay so you've been watching talking with docs for a couple of minutes and you've learned something atrial fibrillation is an arrhythmia so it's an irregular heart rate it happens when the sinus node which normally regulates the heart rate sending out crazy signals and the heart starts beating really fast maybe double normal and it's not a very comfortable feeling when your heart's racing at that pace so that's atrial fibrillation right so someone who presents with atrial fibrillation we always like to do this we talk about what you feel okay how what happens when you go see the doctor what tests are ordered and then how you treat it sure what do you feel like if you got atrial fibrillation so that's that's a tough one um because you we can this can range from i feel nothing yep um to doc i can't i can't live with this rhythm disturbance it's driving me crazy um and so some and so i feel nothing is easy people happen to walk into their family doctor's office they go in for their routine yearly check a doctor listens to their heart goes hmm that sounds kind of irregular that doesn't sound normal they do an ecg the diagnosis is made and then we can talk about treatment afterward the flip side is we have people coming into the emergency department here they have all these palpitations their hearts racing they don't feel well they're lightheaded maybe short of breath and we come and they come in we do an ecg and go up you're in atrial fibrillation let's talk about what we're going to do about this would they typically have pain no no not a painful thing it's not like a heart attack so i think that's important yeah so in in general it's palpitations it's shortness of breath it's light light-headedness okay um those are the common ones and then there's a group in between and it's might be just fatigue or they might just feel short of breath they might just feel off right and those are two more difficult diagnoses and that's why you know if you're always if you're just feeling off go see your family doctor because your family doctor with a simple stethoscope and an ecg can make the diagnosis right away and i think one of the things that's really important before we talk about treatment why are we worried about this like why is atrial fibrillation a big deal at all lay it on me okay so the rhythm disturbance itself is not that big a deal it's a nuisance we know it for some people it can make them feel unwell and we've got some treatments for that the problem is atrial fibrillation can cause a stroke and these are big strokes these are not little strokes so if you have an atrial fibrillation stroke you have a one in five chance of just dying right off okay your numbers are never comfortable no i know they're not i know they're not gotta say that you have a three and five chance of having a stroke where you never get out of bed for the rest of your life if you have an atrial fibrillation stroke you're you only have a one in five chance of having had a stroke with atrial fibrillation and kind of walking out of the hospital and being okay okay so this is why it's a really big deal to us one and five you're gonna die three and five you'll never get out of bed one and five you walk out correct if you have a stroke from atrial fibrillation but right before you panic yes we're going to come to some treatment options that can minimize these chances significantly but we're going to get to that okay so that's why you can't just wander around life with age right fibrillation willy-nilly so so the next question someone's going to ask is how does atrial fibrillation lead to a stroke why do you get a stroke good so good question so if if the heart's working well if the quarterback is is the one that's functioning it squeezes the upper chamber of the heart like this and clears all the blood just as you can imagine but with atrial fibrillation because you have all these rogue pacemakers the upper chamber is just wiggling like a bag of worms and when the upper chamber wiggles like that rather than squeezing the blood really does not flow through efficiently and you know that you know if the blood doesn't flow it clots yeah and uh and so you can get a little clot forming in the upper chamber of the heart it's usually about the size of a dime so that's a pretty big size yeah sure and then if that all of a sudden breaks off and it goes blue and goes up to your head it blocks a big artery in your brain and that causes a stroke okay so that's scary stuff scary stuff now atrial fibrillation just so i can people might have heard of atrial flutter flutter versus fibrillation so the risk of stroke is exactly the same okay okay um the rhythm for flutter is a little bit more organized than atrial fibrillation but essentially our management's identical okay cause i thought flutter was the thing i felt in grade nine in the calf when this girl i was crushing on right can you sat right beside me that could be that that i thought i had a different kind of flutter though yeah it was what it was she always comes back to your high school all right unfortunately did you marry her thank you for asking uh but unfortunately she was more into my friend he was playing the jock angle i was playing them he was the quarterback yeah i was more the nerd angle so no uh she wasn't into me but i got the last laugh because her malignant lack of interest afforded me the time to study for the biology regional contest of which i placed top three so chantelle if you're watching thank you so what is the treatment okay so what's the treatment the first i guess first order of business is if your heart rate's too fast we need to slow it down right okay we need to make you feel better um that's pretty easy you know we have a series of medications from beta blockers to calcium channel blockers in particular those two classes of medications will just kind of slow things down in some countries there's digoxin or taloxin so we use digoxin sometimes now but it's really kind of falling out of favor right but it is also effective for some patients to lower the heart rate so that's that's easy and so sometimes this would be like intravenous in the er but sometimes would just be started oral medications in your family yeah okay yeah and so and actually probably most often in the in the office in the clinic okay especially if the patients don't feel too unwell and nobody likes to go to the hospital if they don't have to go to the hospital especially during yeah so that's option one okay and just quickly if any people like that we have a lot of viewers who are against big pharma okay and and they have problems with medications this is not a fight to pick okay if you're against big farm against medications leave those comments for another one of our videos this one is not one where you can say i don't want to take medication okay this is serious stuff serious risk of stroke serious risk of death medications are necessary here it's not going to be solved with beetroot and garlic which is a very important supplement throw that out there all the people against big pharma that'll save you some typing just last question about the rate controlling agents yep and it's going to come i'm on this forever yeah i think unfortunately because you have an inherent problem with your electrical wiring of your heart that's not going to get better with time yeah you can tell from the tone of my voice i'm hedging a little bit yes um because because there is there are some treatments that we will move to okay going forward where we might be able to really settle this down and we can peel back a bunch of medications um but it's kind of in the acute setting yes we're gonna just slow your rate down control the rate we're going to make you feel better yep um and if you're in a little bit of heart failure with this sometimes people are we kind of manage that as well and you're going to you get into a bit of heart failure because you can imagine your bag of worms of an atrium and your fast rate your heart isn't working efficiently right so it can't maintain your cardiac output fluids get backed up and you end up in a bit of heart failure so yeah this is not an efficient state of heart not at all that's why you end up in a bit of heart failure yeah and if you actually i know i'm not getting into the weeds but if you think about the efficiency of your heart you will lose about 20 to 30 percent of the output with you know when this happens some people can tolerate that well but some people cannot tolerate that well now the next important thing that happens at that visit is we need to get a blood thinner started for almost everybody we there are different scoring systems around the world in canada we use the chad 65 score in europe and united states and elsewhere there's a chad's vasquez score or chad's vasque ii score regardless of where you live in the world there are there is a scoring system that your physician will use to determine do you need to be on a blood thinner or or not and it's really just more risk based um i can tell you that 93 percent of people need to be on a blood thinner it is a very 93 of the people who have atrial fibrillation only seven percent of patients do not need to be according to these chad scores for risk assessment right thank you chad thank you chad okay um and so blood thinners so in the old days we used warfarin yeah um okay so here is uh here's a great bit of trivia okay so what does warfarin stand for we've all we've all heard about warfarin and rat poison we know we can go to home depot and pick it up on the shelf so it stands for the wisconsin alumni research foundation so that's where warfarin was discovered there were cows that were dying uh years ago in the 1920s and the 30s they were eating rotten clover and this was the active ingredient that determined oh it's it's it's warfarin in the clover that is causing this problem makes sense kills the animal it's going to stop your heart from clotting so yeah so we can see the leap there so we need no we're not using so much warfarin that it will kill you obviously so um and most countries in the world don't really use warfarin anymore so warfarin was the only thing we had for 50 years it is very good for preventing stroke and the setting of atrial fibrillation the only downside with warfarin is that you need to get your blood tested about every three to four weeks to monitor the levels um there are a lot of food and drug interactions with warfarin and there's always of course the risk of bleeding sure so that's where big pharma did come into play so they said look we got to find something better than the girlfriend it's been the king for 50 years i think we can do a better job right a number of these medications are actually now going off patent or already off patent so big pharma is not involved anymore although they developed it right and so there are four drugs now available in place of warfarin where you don't need to have your blood tested every day okay you can just take the standardized dose and they are very effective at reducing the risk of stroke okay excellent and i'm the one thing about warfarin i know we've been sort of you know talking about how how it wasn't the greatest drug it was reversible that was a nice thing as surgeons we like the fact that it's reversible because if we had a patient coming in on warfarin and we need to do surgery we knew how to reverse and vitamin k was pretty well the thing right because i mean kate wore for the vitamin k and it was really cheap yeah very very inexpensive so you know and it and it served us well for many many many years but now we have more elegant medications that people have a more reproducible reaction to so they don't need to check their blood every week and right for the novel orals i guess yeah that's actually a good question but so do you need any baseline blood work to find out is it is this unsafe are these anticoagulants unsafe in any population other than people obviously that have a bleeding disorder um yeah so that's really what we're looking for is bleeding disorder okay you know is your blood count too low uh is the platelet count in your body too low the platelets you know are part of the clotting mechanism and a lot of these medications are uh they don't people misinterpret this sometimes they don't have an effect on the kidneys but they leave the body through the kidneys right and so we have to check kidney function just so we know that the kidneys are working well enough so that this can leave your body so you just reduce their dose we reduce the dose okay yeah sometimes if the kidney function is so poor that for instance you might have to be on dialysis these are not medications we would use in that patient population in canada okay okay so cool so blood thinners we used to have warfarin we have some newer more elegant ones now uh so atrial fibrillation your blood thinner you're asking is it for life is it for that i was gonna actually go for the anticoagulant as well for life any coagulant for life yes yeah so that's regardless so you now have a diagnosis and uh and there's always a risk no matter what we do in terms of the drugs we may use to try and keep you out of atrial fibrillation or we may send you forward invasive management you know we may put a tube up into your heart we may map out where the atrial fibrillation is coming from we may freeze or burn away the little circuits that are causing that so we can do that as a treatment for many individuals especially people who are experiencing symptoms for those individuals we might peel back some of those things i was talking about like the beta blockers or calcium channel blockers but the blood thinner almost always stays okay because while those are great treatments they're not 100 effective it's not like surgery right or it's 100 guaranteed that you're going to save the day right there's a 100 chance you're gonna get your knee replaced there's not a 100 chance you're going to be 100 happy okay most people are very very happy but there is it's going to be solved i would agree with that okay okay yeah all right so that is and now it what about nuance at atrial fibrillation any sort of less invasive procedures we do to convert people into back into a sinus rhythm yeah so that's where the emergency department comes into play just talked to a lady last night who called my office and said look she has this diagnosis it comes and goes i guess we didn't talk about that some patients atrial fibrillation is there all the time but for many people it comes and goes normal rhythm not normal rhythm normal not normal so she calls the office hey dr heffernan i'm back in this rhythm i feel terrible and i said okay you know what to do i just need you to go to the emergency department i'll call ahead and the merge doc will see you they're going to slow the heart rate down make you feel a little bit better you're on your blood thinner you've been taking it religiously now they're just going to put you to sleep for about five minutes and shock you back to a normal rhythm just like you see on the tv okay um clear yep simple procedure an hour later she can leave the hospital back into normal rhythm feeling well and how how often can you do that like is that is that something that she would do regularly potentially or yeah well you can do it a lot because it doesn't hurt the heart right um it's uncomfortable for people sure it's not a practical way to it's not a practical way to live so you should change your medication you would change the medications or you know the management yeah and i guess we there's a class of medications we haven't discussed called antiarrhythmic medications um these are medications that are specifically designed to try and keep you in a normal rhythm we tend to use those medications before we float something in your body and trying to burn or freeze things away um they're okay um they're not perfect they work probably about 50 percent of the time and the irony is the one that's the most effective has the most side effects and so while we we use it in some individuals we really often don't like to um and and only kind of use it if pushed so it's a really it's a difficult diagnosis to have for the patient and you should also recognize that it's also difficult for physician on the other side of the table um because we you know we've got great medications for other conditions um we don't have great medications to try and keep you in a normal rhythm we have great medications to prevent stroke yeah okay last question i would have because someone's gonna ask this for sure so did this happen because of something that they did and is there anything i think i know the answer is there anything they can do to to reverse somebody what if i exercise what if i change my diet what if i'm really strict and i just live a perfect life hey could that prevent it and b can it solve dr weaning has eased us into the risk factor discussion that's part of our video what are the risk factors and i'm afraid to ask this one because my father he was a great man i mean he rest in peace he had atrial fibrillation now so i can live in peace and i'm afraid to ask but the hereditary nature super small component hereditary super small okay okay uh so when i give this lecture to family doctors the thing that i i i try and instill and remind them is the three most common causes of atrial fibrillation is hypertension hypertension and hypertension okay what about hypertension does that play a role that's blood pressure control so if you have poorly controlled blood pressure it will just stretch your heart it stretches that upper chamber and it can give rise to atrial fibrillation because it's just pushing it's so much resistance that's just too hard it wears it out where's the pump yeah it starts to wear it out and and the upper chamber is quite thin and it's easy to stretch so we have a video on hypertension we do your blood pressure so check that out to treat it so make sure your blood pressure is well controlled um next is sleep apnea okay so also a very common cause of atrial fibrillation yeah so so if your loved one or if you often people don't know it themselves but if people complain that you snore not so much snoring but if you seem to stop breathing when you're sleeping if people are nudging you because they think that you're dying every night and they need you to breathe again then you probably have sleep apnea you should have a sleep study to actually confirm it but sleep apnea is a big cause of atrial fibrillation so much so that the guys that go in and the gals that go in to do the freezing and burning yeah often won't do it unless you've ruled out a rule that sleep apnea is a cause because it's really treatable right i gotta go get my affairs in order yeah okay so sleep apnea is a big one hypertension sleep apnea which is treatable and uh i think we have a video coming up yeah we're working on a video background research on the sleep apnea video thyroid function we always check because if somebody's thyroid is over active that might uh that might lead to it those are the big ones okay okay that's i i tell you i've learned so much about atrial fibrillation this morning and it's a very very useful video one more question um you know now there's a lot of fancy watches available wearable technology i've got one of those watches it can tell me when i got to get up and sit down it could tell me what my memory when to breathe ironically it doesn't really tell me the time or i can't figure out how to do that but it can also detect atrial fibrillation do you trust these wearable technologies for this kind of stuff so it depends on the manufacturer so so apple apple actually has um a medical grade ecg i know it's health canada approved i'm pretty sure it's fda approved i'm not aware of the other health agencies in the world so it is trustworthy as a single lead ecg that has its own kind of difficulties um but but yeah so i wouldn't start somebody on a lifelong blood thinner based on an apple watch ecg reading but it would prompt me then to do additional tests with more sophisticated um measures to just absolutely confirm it well and the diagnosis of atrial fibrillation does not need a ton of expensive tests basically the stethoscope is your first yeah and some very simple monitors that we can have people wear for you know even a couple weeks okay yeah that is an awesome summary wow yeah yeah that's a lot does that mean a lot of yeah one video yeah you might have to press pause and watch this video and get a copy but if you like it don't binge this video don't binge but if you like it please like this video and subscribe to our channel and remember you are in charge of your own health thanks again to dr heffernan for joining us today thank you so much for discussing matters of the heart thanks for having me guys we'll see you next time

Channel: Talking With Docs

Views: 106,962

Keywords: arrythmia, heart, heart rate, heart beat, fast heart, chest pain, Warfarin, Eliquis, Pradaxa, Xarelto, Coumadin

Id: z-xSskDOWy0

Length: 22min 22sec (1342 seconds)

Published: Fri Mar 11 2022