What Is AFib?

            It’s likely that someone you know has experienced atrial fibrillation or AFib as it’s more often called.  The symptoms vary and may include heart palpitations as a flutter in your chest, pain, and pressure in your chest, a confused feeling, dizziness, shortness of breath, or general weakness.  As you likely noticed, the symptoms of AFib are common to many other issues we might dismiss as just a bad day.  Without specific tests, it’s challenging to diagnose.

            The cause is faulty electrical signals that make your heart flutter or beat too fast. The abnormal rhythm keeps your heart from pumping as efficiently as it should.  In some cases, blood flow can slow enough to pool and form clots.  When diagnosed early enough, treatments are available that make AFib far less likely to lead to a stroke or other health complications.

            Rather than give you more about my perspective on AFib, I’ll share with you what you would have heard on a recent walk with a cardiovascular doctor.  The doctor is David Sabgir, MD, a cardiovascular specialist.  As you may recall from previous newsletters, Dr. Sabgir discovered he was spending quite a bit of time during appointments, advising about how to live a healthier life but in the end not having the success he wanted in getting patients to make the needed lifestyle changes.  From that realization, the program called “Walk With a Doc” was born.  If you missed these previous stories about Dr. Sabgir, just click the links below.

  1. Are Stents the Answer?
  2. A Good Lifestyle Can Be Good Medicine

            With that as the back story, Dr. Sabgir will take over now.  Just imagine you’ve joined Dr. Sabgir on a morning Walk With the Doc and you begin with, “Hey Doc, just got a couple of questions.”  Ok, David replies, “So what’s on your mind.”

So, what is AFib?

Atrial fibrillation (aka AFib) is one of the most common heart rhythm problems. It is an irregular activity of the heart that usually comes from the roots of the pulmonary veins.

My heart skips beats a lot. It will go like boom-boom-boom-then nothing-then boom. Is that AFib? 

Probably not. It’s likely Premature Ventricular Contractions (PCs) and/or  Premature Atrial Contractions (PACs)  They are much more common. Good idea to check with your personal doc.

That doesn’t sound very scientific. How do I find out for sure?

If you are noticing a racing heartbeat, an irregularity, or something that concerns you; you should let your doctor know. They will possibly want you to wear a Holter monitor for 24-48 hours or possibly look into one of these (not a sponsor) personal devices.  Monitors like these show us exactly what your heart electricity is doing.  There are multiple different rhythm issues and many ways to treat them.

What causes it?

The most common risk factors for AFib are high blood pressure and coronary artery disease. We also see AFib with heart failure, certain valvular diseases (mitral is most frequent), excessive alcohol use, sleep apnea, tobacco, an overactive thyroid, and several other issues. Its incidence certainly increases with age, but I’ve seen a couple of young ones recently with AFib due to ‘energy drinks’. Coffee and energy drinks were in the news recently as possible reasons.

I like it better when you talk about goofy stuff.

That’s not a question.

Ok, I like to make things really simple. AFib goes undiagnosed a lot (most people are asymptomatic), and it causes TIAs (transient ischemic attacks) which is a stroke that goes away within 24 hours, more severe strokes, heart failure, and some other stuff.

If heaven forbid you’ve had a TIA or a stroke, I would ask your doc if AFib is something they want to look into. Many, many times when we are treating someone who presents to the emergency department with a stroke, we hook them up to telemetry, and they are in AFib, or they show bursts of it sometime during their stay.

I don’t want AFib.

Well said. I don’t want it either. AFib is often a symptom of another condition (hypertension, Coronary Artery Disease (CAD), heart failure, etc.). So, we need to avoid those.

Walk. Seriously, if you maintain 150 minutes a week, and keep that BMI in a respectable range, you will dramatically reduce your risk. And, easy on the Red Bull/Vodkas.

Why did you start a sentence with ‘And’?

I’m not going to answer that.

What happens to me if I get AFib?

It doesn’t cause heart attacks, and it doesn’t cause you to drop dead, but it does raise your risk of stroke. With the correct treatment, you will forget that you have it, and you will remain a ‘normal’ person. IMO, these are the three things you need to do (in order of importance):

First thin the blood If you have congestive heart failure, high blood pressure (>140/90), if you’re 65 or older, have diabetes, vascular disease or you have had a stroke you need to talk with your doctor about being on a blood thinner. Coumadin, Pradaxa, Xarelto, and Eliquis are all possible options.  This tool and this tool are 2 calculators we often use when deciding whether or not to thin the blood.

Which blood thinner should I take?

I’m not touching that with a 10-foot pole. That’s my day job. It’s an important discussion for you to have with your doctor; each option has pros and cons. The key is taking one.

I hate blood thinners. What about aspirin?

A lot of people do, but they really reduce your risk of a stroke. Aspirin, for AFib, doesn’t cut it. I wish it did.

The second important part is to slow the heart rate:

A mnemonic device for heart rate slowing drugs is BCD. Beta-blockers, calcium channel blockers, and digoxin. Of course, heart rate control is a must.

Finally, the third part is to get the heart back in rhythm (yep, this is the least important): Studies have definitively shown that most people have no idea they are in AFib.  Many docs like rate control (blood is thin and heart rate is not too fast.  I like less than 80 bpm at rest and less than 115 with exercise. Studies show the quality of life is going to be better than if they keep coming back to get shocked. Guidelines say in most cases it’s a good idea to cardiovert once, but to avoid excessive use. It’s not a safety thing; it’s just not necessary.

What about ablation? I think my neighbor had that.

There are certainly times when ablation is indicated, but not as often as you might think. Best to discuss with your cardiologist and see if you are a good candidate.  It’s a complicated issue, and I’ve probably already gone on too long.

Enjoy your weekend!

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            I hope you enjoyed the virtual walk with Dr. Sabgir.  It’s amazing what can happen on a walk.  Even my dog (Pebbles) finds the walks amazing.  By the enthusiasm she shows for Saturday morning walks, I suspect my dog (Pebbles) gets more from them than I do.  That’s saying a lot given how refreshing a morning walk around the lakes can be.  By starting the day early, I still have time for an 8:00 stop at the farmer’s market at St. Thomas Episcopal Church on Bailey Cove.  If you can’t make the morning walk, perhaps you can join me for fruit and veggie shopping.  At the top of my list will be local watermelons and peaches.  Last week they were soooooo good.  Alas, the kid in me and I agree, summer is passing far too fast.

            Nancy Neighbors, MD

AFib Facts

Approximately 5 million Americans have AFib.

AFib patients are 5 times more likely to suffer a stroke.

15% to 20% of strokes are AFib related.

Published by Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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