Atrial Fibrillation: Symptoms, Risk Factors and Treatment

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here is your host, Deborah Howell.

Deborah Howell (Host): Hello and welcome to our show. You are listening to Weekly Dose of Wellness, brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Sinjin Lee. Dr. Lee graduated cum laude from the University of California, Berkeley. He completed his M.D. degree at Albert Einstein College of Medicine in New York, where he graduated AOA with additional distinction for research in cardiology. Dr. Lee went on to satisfy his internship and residency requirements at the Duke Medical Center in Durham, North Carolina. He continued his four-year cardiology fellowship training in both cardiology and electrophysiology at Beth Israel Deaconess, a teaching hospital of Harvard Medical School in Boston. He's board certified in both cardiology and electrophysiology, and is now affiliated with Saddleback Memorial Medical Center. Welcome to you, Dr. Lee.

Sinjin Lee, MD: Oh, good morning. Thanks for having me, Deborah.

Deborah Howell (Host): Today we're going to be talking about atrial fibrillation. We hear so much about it, but many of us still don't really have a good idea what it involves. So in layman's terms, what is atrial fibrillation?

Sinjin Lee, MD: Sure, I’ll gladly talk about this topic, which is a very important condition. Atrial fibrillation is essentially refers to an abnormal electrical activity inside the heart, which leads to a disorganized electrical activity in the atrium, which is the upper chamber of the heart essentially.

Deborah Howell (Host): And so what would cause that kind of activity?

Sinjin Lee, MD: Unfortunately, people, we still do not know the actual cause of this. However, we do know that it is usually a condition of aging population. So this is a very common problem and it is known that by the time you reach the age of 80, approximately 10% of the population have this condition.

Deborah Howell (Host): Really? And still, really, the cause is unknown.

Sinjin Lee, MD: It's unknown. There are many risk factors. Certainly there are some genetic components to it, and then there are some patients where the risk factors include the usual hypertension, structural heart disease, diabetes. The typical cardiac risk factors are certainly increased risk for developing atrial fibrillation. However, there are even situations where people are extremely healthy - a marathon runner, for example, who develops this condition at a young age.

Deborah Howell (Host): Wow. Okay, so this is happening, this electrical activity. What are the symptoms that a patient feels?

Sinjin Lee, MD: To be honest with you, surprisingly, the majority of the patients don't feel this. So this is actually most commonly discovered accidentally if you happen to just go see a doctor and your physician might just note that you have an irregular heart rhythm, for example. Or they may do a very simple test, something called an EKG, as an electrocardiogram, where they actually only find this as, for example, prior to undergoing surgery, for example.

Deborah Howell (Host): So people are walking around, this is happening in their hearts, they don't know it. A doctor discovers it by accident. And then what happens?

Sinjin Lee, MD: That's what I would say. Yeah, I mean, I would say that's about half of the patients, these conditions are discovered by accident. There are patients where they feel irregular heartbeats - palpitations, for example. Or when you're elderly folks - when the patients are elderly, they tend to feel more of a fatigue or just low energy. And rarely, some patients might just feel dizzy or they describe it as giddiness, and they go to see a doctor and this is what's discovered.

Deborah Howell (Host): Interesting. So this is different from congenital heart disease.

Sinjin Lee, MD: Very different. Congenital heart disease is a very generic, non-specific term where you're born with any type of a heart condition that you're born with. Atrial fibrillation is funny in that it's an electrical problem. So if you actually look at the heart initially, there's nothing wrong with the heart itself. And this electrical conduction problem is not something that you can see with your own eyes. However, if you leave this on for a long time, this does eventually lead to enlarged heart and other heart problems eventually.

Deborah Howell (Host): That was why my next question: so why should we be concerned about it?

Sinjin Lee, MD: Sure. So atrial fibrillation by itself is not a life-threatening condition. However, there are two things that are certainly a - that can lead to very serious condition. One is a stroke, and the second problem is congestive heart failure, which is a symptoms that consist of being short of breath, your legs swollen, and not being able to breathe well at all, especially when you're lying down.

Deborah Howell (Host): Yeah, that would be a concern.

Sinjin Lee, MD: Yes.

Deborah Howell (Host): But does AFib itself put a patient at risk for stroke and heart failure?

Sinjin Lee, MD: It does. Atrial fibrillation - and the reason that being is when you're in atrial fibrillation, because your heart is not having a normal electrical activity, the blood flow going through the heart gets distorted. And what happens is that the chambers inside the heart begin to form clots, and those clots can be sent out of the heart, and the first place that the blood goes out of the heart is to your brain, which is what a stroke is, okay? In terms of a congestive heart failure, the reason that that can develop is that one of the common findings of atrial fibrillation is that your heart is racing. So you may not be aware of it, but even when you're resting and you know, just relaxing, when you're in atrial fibrillation, your heart may be racing at 120 beats per minute, okay?

Deborah Howell (Host): You know, this happened to my sister, and it happens only when she's driving.

Sinjin Lee, MD: Oh, really? Yeah, so and contrary to belief, these things actually don't happen with activity. They usually happen right after activities or when you're at rest. And your heart is normally supposed to race when you're angry or when you're emotionally upset or exercising, but when you're relaxed, your heart should not be racing that fast. And if it's doing that for a while, your heart eventually tire out and lead to congestive heart failure.

Deborah Howell (Host): Do you think it might be stress related, even though a person resting might have - I mean might be a delayed reaction from earlier stress?

Sinjin Lee, MD: Sure, and that is actually a very common response by patient is that, "Oh doc, you know, I think you know, I'm just going through a lot of stress." We don't believe so. I mean, certainly stress never helps you. Stress certainly increases risk of heart disease, and certainly it doesn't help in terms of developing anything that's related to cardiac related conditions. But stress alone is not the trigger of atrial fibrillation. And there are also other common myths about atrial fibrillation trigger, and they include chocolates, caffeine, any of those sorts, and none of them have actually been convincingly shown to be the trigger of atrial fibrillation.

Deborah Howell (Host): It remains a mystery. Well, I'm sure you guys will figure it out someday.

Sinjin Lee, MD: Right. The only two that we know for sure has an association is alcohol consumption, as well as having a condition called sleep apnea, and if untreated can lead to a high risk of having atrial fibrillation.

Deborah Howell (Host): Okay, so now let's talk about prevention.

Sinjin Lee, MD: Sure. Well, because it's a condition that is first of all hard to detect, certainly the first thing you can do is avoid two known risk factors. And one is if you drink fairly heavily, I think you should certainly cut that down. That's common advice from a physician to patients.

Deborah Howell (Host): And what's your definition of fairly heavily?

Sinjin Lee, MD: So you know, I would say for men, one to two drinks a day is fair. And for women, a glass a day is fine, okay? What you cannot do is save it for entire week and then drink all all seven drinks in a day. That's not what you should be doing. But certainly a small dose of alcoholic beverage is actually has a paradoxical effect of being good for the heart. So it is okay to drink, but you need to everything in moderation, obviously.

Deborah Howell (Host): Go for the red wine, ladies.

Sinjin Lee, MD: Exactly. Yeah, and in terms of sleep apnea, that is a very common condition. It's almost an epidemic in the United States because of the increasing obesity in the country. And some of the telltale signs of a sleep apnea would be heavy snoring, and especially if you stop breathing in the middle of the night that your partner notices, you should certainly be evaluated for a sleep - sleep apnea and have that treated, because that will certainly lower your risk of atrial fibrillation.

Deborah Howell (Host): Okay. Now that we've prevented it, you know, let's also talk about those who have sadly, you know, given in to it, and so we need some treatment options.

Sinjin Lee, MD: Sure. So the first thing to say about atrial fibrillation is unfortunately there's no perfect cure for this rhythm, okay? So the way to manage this is one, because it is - it can lead to a stroke, the most important therapy for atrial fibrillation is that when you're diagnosed with it, you need to be on a blood thinner. Traditionally you had to be on a medication called Warfarin or Coumadin, which a lot of patients don't like taking because it requires you to monitor your blood. But for the past three years, there have been some alternative blood thinners that came out on the market that does not require blood checks anymore, which makes it a little more convenient for the patient, okay? The second issue is that because you can develop congestive heart failure, which is due to your heart from racing uncontrollably, usually medications that you're initially placed on are what we call rate control medications. And if they're not effective, the cardiologist - usually electrophysiologist - will start you on a medication called anti-arrhythmic medications, which are designed to keep you in the normal rhythm.

Deborah Howell (Host): And are these - are these effective?

Sinjin Lee, MD: They are about 50/50. They either work or they don't. The blood thinners are effective. In terms of the rate controlling and the rhythm controlling medications, they're about 50/50. And as a result, if the medicines are not effective, certainly patients also have an option to undergo surgical procedures, sometimes known as ablation, which is what electrophysiologists usually provide.

Deborah Howell (Host): So I think we need a whole another show on ablations, that's what I think.

Sinjin Lee, MD: Yes, it does. It's a pretty complex area and it's an extensive topic. Sure.

Deborah Howell (Host): Well, we thank you so much. Our time, speaking of racing, has raced, and we really appreciate you finding time to talk to us today about the symptoms, the risk factors, and the treatment of atrial fibrillation.

Sinjin Lee, MD: Thank you for having me, Deborah.

Deborah Howell (Host): Well, you know, that's what it's about. It's about getting information out to the public. We hope you've enjoyed our show today. It has been a real pleasure to have Dr. Lee with us, Dr. Sinjin Lee. And of course you are joining us again next time and we'll be exploring another Weekly Dose of Wellness. It's all brought to you by MemorialCare Health System. We hope you have a fantastic, healthy, preventive day. I'm Deborah Howell. Have a wonderful one.