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Walk with a Doc Newsletter
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Good morning! Hope this week's communication finds you well and getting ready to go get your 10,000 steps today. Before we talk about atrial fibrillation (aka - A Fib, atrial fib), there's something we need to address.
We love dogs. You probably know that medical studies show a huge benefit to owning dogs for multiple reasons, not the least of which is you've got someone asking you to walk everyday.
Recently, we've been getting a rash of emails that read something like this:
"Kathryn, are you proud of me? I walked 5 Miles yesterday, today, and probably will again tomorrow!"
"David, wazzup! You will be excited to hear I walked All Day today!"
"Liz, I walked Forever yesterday!"
There is nothing we like to hear more, then...
We later found out that there's a Walk with a Dog (rescue Bulldogs) and a Doc club in Cheyenne, WY where the veterinarian, likely to provoke us, encouraged the new pet owners to literally name their dogs, 5 Miles, All Day, and Forever.
As the frequency of these emails to our office increases, and we do notice other regions of the country are catching on, we want you to know something...
WE ARE ON TO YOU PEOPLE!
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 What is it? Atrial fib (aka A Fib) is the most common rhythm problem of the heart. It is irregular activity that comes from the top chambers (atria) of the heart. My heart skips beats a lot. It will go like boom-boom- boom-then nothing-then boom. Is that A Fib?
Probably not. It's likely PVC's and/or PAC's (premature ventricular/atrial contractions). They are much more common.
That doesn't sound very scientific. How do I find out for sure?
If you are noticing a racing heart beat, 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. That will show us exactly what your heart electricity is doing. There are multiple different rhythm issues and many are treated different ways.
What causes is it? The most common risk factors for a fib are high blood pressure and coronary artery disease. We also see a fib with heart failure, certain valvular disease (mitral is most frequent), excessive alcohol use, sleep apnea, and several others. Its incidence certainly increases with age, but I've seen a couple young ones recently ('energy drinks').
I liked it better when you talked about balloons and stents.
So did I, and that's not a question.
Okay, I like to make things really simple. A fib goes undiagnosed a lot and it causes TIAs (transient ischemic attack which is a stroke that goes away within 24 hours), strokes, heart failure, and some other stuff.
If G-d forbid you've had a TIA or a stroke I would ask your doc if a fib is something they want to look into. Many, many times when we are treating someone who presents to the ED with a stroke, we hook them up to telemetry and they are in a fib or they show bursts of it sometime during their stay.
I don't want a fib.
Well said. I don't want it either. A fib is a symptom of another condition (hypertension, 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 a fib?
It doesn't cause heart attacks and it doesn't cause you to drop dead. With the correct treatment you will forget that you have it and you remain a 'normal' person. These are the 3 things you need to do (in order of importance):
1) Thin the blood - If you have congestive heart failure, high blood pressure (>140/90), if you're 75 or older, have diabetes, or have had a stroke you need to be on a blood thinner. Coumadin, Pradaxa, Xarelto, and Eliquis are all possible options.
Which one should I take?
I'm not touching that with a 10 foot pole. That's my day job. Now I'm just kickin' back with my dog writing a newsletter.
It's an important discussion for you to have with your doc - each option carries lots of pros and cons. The key is taking one.
I hate blood thinners. What about aspirin?
A lot of people do but they essentially normalize your risk of a stroke. Aspirin, for a fib, does jack squat.
2) Slow the heart rate:
Mnemonic device for heart rate slowing drugs is BCD. Beta-blockers, calcium channel blockers, and digoxin. Ivrabadine is only in Europe and doesn't fit in the mnemonic. Obviously heart rate control is a must.
3) 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 atrial fib and if their blood is thin and heart rate is not too fast (I like <85 bpm) their 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 that is indicated, but not as often as you might think. Best to discuss with your doctor/cardiologist and see if you are a good candidate. Outside the realm of this newsletter which has already gone too long. |
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Broken record here, but if you maintain those 150 minutes a week you likely won't have to deal with any of that cr*p I just rambled about.
You are in charge.
Maverick...Call the ball.
David | |
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