Just about everyone has experienced an abnormal heart beat, but when do you need to see a doctor? National Jewish Health Electrophysiologist, Raphael Sung, MD, explains more and answers FAQs.
Alyssa Paschke: Hello and thanks for tuning in to our live Q&A. Today I'm speaking with Raphael Sung. He is an electrophysiologist at National Jewish Health, St. Joseph Hospital and the Platt Valley Medical Center. Heart arrhythmia is the term used for an abnormal heartbeat. That could mean a higher heartbeat, slower heartbeat or an irregularity. And today we're going to learn about this condition. How it occurs, symptoms to watch out for and the treatments that are available. If you have questions as we go along, feel free to type in a comment and we'll try to get to as many as possible.
Alyssa Paschke: Thanks so much for joining us today Dr. Sung. I think this is an important topic to discuss with the audience and out there we see a lot of commercials about AFIB and that's atrial fibrillation. Could you explain to the viewers what heart arrhythmia is and are there different types of arrhythmias?
Dr. Sung: Absolutely. Thanks Alyssa and your team for having me here.
Dr. Sung: I thought it might help if I explain a normal heartbeat first. That might help the viewers understand arrhythmias a little better. This is a model of the heart and it sits in the chest like this. This is the right side of the heart and the left side. You can see that it's divided into four chambers. There's two in the top called the atria, two in the bottom called the ventricles and that helps for efficient blood flow. In terms of a heartbeat, it's controlled by electrical signals. There's two important electrical structures to remember. There's one here in the top right part of the heart called the sinus node and one here right at the center called the AV node and it all starts here at the sinus node.
Dr. Sung: This structure can sense how much blood a body needs. If you're resting, it's going to beat slower and as you're doing activity, it'll beat faster and faster to allow more blood flow. Signals are sent from the sinus node through the atria, telling the atria to squeeze and push blood down to the bottom, the ventricles, filling it up. And then this AV node will pick up the signal from the top and then you can see electrical wires extending from the AV node, telling the ventricles to beat and that's what pushes blood out of the heart to your body.
Dr. Sung: In arrhythmia there's three different types, broadly speaking. There's heart rhythms that are too slow for the heart, heart rhythms that are too fast and heart rhythms that are irregular. If we talk about slow heart rates, they usually come across because of disease in those two electrical structures, the AV node and the sinus node. Damage or disease in those two structures will lead to inappropriately slow heart rates.
Dr. Sung: You can have circuits or short circuits somewhere, anywhere really in the heart. It could be in the atrium, it can be in the ventricles and that leads to very fast heart rates, anywhere between a 100 or 200 beats per minute. When the heart tries to beat that fast, again poor blood flow and you can get symptoms related to that.
Dr. Sung: Irregular heartbeats, irritable spots anywhere in the heart that leads to an extra heartbeat coming out.
Dr. Sung: Those are the three categories I think about.
Alyssa Paschke: Got you. Well the visual aid definitely helps explain that for sure. Sometimes people can experience a faster heart rate maybe due to stress or anxiety, physical activity, maybe a little bit too much caffeine, things like that and usually those symptoms pass over time but when should someone be concerned about an irregular heartbeat, too fast and when should they visit a doctor?
Dr. Sung: That's a great question. The challenge is that symptoms in and of themselves are oftentimes not going to be reflective of what kind of arrhythmia they have. Some people can have potentially life threatening arrhythmias and remain completely asymptomatic and other times people can have very benign arrhythmias or sometimes no arrhythmias at all and can have really horrible symptoms.
Dr. Sung: But the general rule of thumb, if you have any episode of lightheadedness, dizziness, feeling like you're going to pass out or actually passing out, those are all things that should be evaluated. Other things like shortness of breath, activity limitation, shortness of breath with certain exercise whereas normally you're able to do it but then all of a sudden you have difficulty doing it. Especially if they come and go. All of a sudden you get any of those symptoms that pop up for no apparent reason and then all of sudden resolve again, those are all important things that should be checked out.
Alyssa Paschke: Got you. Is heart arrhythmia a dangerous condition? I know you mentioned it could be potentially life threatening.
Dr. Sung: It comes in all different flavors. You have some that are imminently life threatening, the next episode of that particular arrhythmia could be fatal and you have some that are very benign. No symptoms whatsoever and not going to increase any issues in terms of future risk of stroke or other disease. And it just depends on the type of arrhythmias.
Dr. Sung: You have life threatening ones and ones that are benign. There are some arrhythmias that in and of themselves aren't dangerous but if they cause enough symptoms, can lead to potentially dangerous circumstances like if you get lightheaded or dizzy, you feel like you're going to pass out or you do pass out, with one of these arrhythmias, then we worry about the trauma associated with it.
Alyssa Paschke: Got you. Okay. How, along with the symptoms and somebody might come to you with those sorts of things, how do you diagnose the arrhythmia itself?
Dr. Sung: Yeah, good question. The best way of diagnosing an arrhythmia is to have a monitor on at the time that the arrhythmia is happening. These monitors if you think about an EKG, what they do is they record the electrical signal in the heart and we can determine what the heart rhythm is. The challenge with this is that sometimes these arrhythmias or the symptoms are very infrequent.
Dr. Sung: Someone might come in with an episode of passing out once every two years and they go into the emergency room, they get an EKG, blood work, imaging tests, everything comes out clean and then they go to their physician, maybe they get a monitor on for one day and that looks completely normal. The problem is that we haven't seen what's going on with the heart during the episodes where they have these events and it's important to figure that out. There are different tools that we have to try to sort out for certain circumstances like that where it's infrequent.
Alyssa Paschke: Got you. Well I wanted to take a second to see if we have any questions that have come in from the audience.
Speaker 3: Yes, one question is, AFIB hereditary?
Dr. Sung: It's a good question. The short answer to that is in some cases yes we do see significant family line generations of atrial fibrillation being passed down. What I mean by that is, grandma had AFIB at an early age, father has AFIB at an early age and now I have AFIB at an early age. Well in cases like that, there probably is some degree of genetic preponderance for developing AFIB. AFIB is one of the most common arrhythmia issues and it's a disease of age. Just like high blood pressure. For the same thing with high blood pressure, there may be some genetic predisposition but at the same time, as we get older, we are at higher likelihood of developing hypertension or high blood pressure. Same thing with atrial fibrillation. As of now, there's no one clear gene, except for some rare cases, that causes atrial fibrillation or no way to test for it really.
Alyssa Paschke: All right so any other questions that have come in? Okay, to continue with this, what are some of the available treatments if you do have an arrhythmia? And are they different depending on the type you have?
Dr. Sung: Yes. Absolutely. I classify it into three broad categories. The first is medications. Medicines are easy to take. Just a pill that you take and it could be once or three times a day. The issue with medications is that it's not a cure. These are trying to control heart rhythm problems. You oftentimes as a result of that have to take it for the rest of your life. The other issue with medications is that it oftentimes can lead to side effects or potentially dangerous sets of circumstances.
Dr. Sung: The second class of treatment options are surgical implants. Things like pacemakers or defibrillators. Pacemaker is really designed to treat slow heart rate problems and defibrillator is to manage life threatening arrhythmia problems.
Dr. Sung: And then the final category is what we call electrophysiology study and ablations. These are procedures, not surgery, but small plastic tubes called catheters going in through a big IV and then it travels up the vein and into your heart and the idea of this electrophysiology study is to get the arrhythmia to come out and if we can figure out where it's coming from, then we can do precise cauterization in the heart called ablations to potentially cure and get rid of the arrhythmias.
Alyssa Paschke: Wow. That is really interesting. Once you're diagnosed with an arrhythmia, are there different lifestyles changes besides maybe the treatments that you've just mentioned that you can incorporate in order to kind of maintain health and not have any serious episodes?
Dr. Sung: Yeah, unfortunately the vast majority of arrhythmias probably aren't going to be impacted by lifestyle change.
Alyssa Paschke: Got you.
Dr. Sung: There are some rare cases where for someone a particular set of lifestyle habits may lead to an arrhythmia. As an example, young people, they may tend to get atrial fibrillation anytime they drink alcohol or some people susceptible to a certain arrhythmia with caffeine intake. Other people it might be sleep and some it may be exercise. The general rule of thumb I follow is that we should probably try to take care of these arrhythmias so that they can lead a normal life. It's unrealistic if someone has these arrhythmias pop up every time they sleep to say, "You can't sleep." Or every time they get exercise induced arrhythmia, to say, "No exercise," to avoid the arrhythmia. Probably better to take care of the arrhythmia so they can lead a normal life.
Alyssa Paschke: Sure. Well that's really good to know. Any other questions that have come in?
Speaker 3: Yes. Maria asked, what is the risk of blood clots if you have AFIB?
Dr. Sung: Great question. How much time do we have?
Dr. Sung: It's personalized. With atrial fibrillation there is potential risk for increased risk of stroke. There are risk factors that we talk about and there are numerous different, what we call calculators to try to sort out what an individual's risk of stroke is related to atrial fibrillation. Things that we think about whether they have underlying heart disease, heart failure, whether their heart doesn't squeeze as well, whether they have diabetes, high blood pressure, gender, and age is quite important. Lots of different factors that go into it and we come out with a specific number for that individual saying, "Your yearly risk of stroke is X."
Dr. Sung: There are a lot of questions that we still haven't answered. Things like, if you have more atrial fibrillation, does that increase your risk of stroke? If you have no AFIB, although you have the diagnosis but let's say you haven't had any AFIB over the last two years, does that reduce your risk of stroke? And these are all things that we're still trying to develop an answer for.
Dr. Sung: In general, if your physician says you should be on a blood thinner, then you should probably remain on one, potentially for the rest of your life, regardless of whether you're going in and out of atrial fibrillation, whether your AFIB is present all the time or not 'cause there's some emerging data that suggests even if you're not having AFIB at the moment, it doesn't necessary reduce your risk of stroke.
Alyssa Paschke: Well great question. Anything else.
Speaker 3: Yes. Alexandra asks, does coffee increase episodes?
Dr. Sung: In general, there is a lot of emerging studies on this and the difficulty is getting a precise and accurate assessment of coffee intake over a large population and then trying to correlate it with arrhythmias. What I usually tell my patients, it's overall unlikely that one cup of coffee is going to significantly exacerbate someone's arrhythmias. I generally say, "It's okay." With the caveat that for you, if you drink coffee and that seems to illicit arrhythmias, then yes, for you, you should probably try to avoid it or if it's one of those things you can't avoid, then try to take care of the arrhythmia first.
Alyssa Paschke: Makes sense.
Speaker 3: One more question. Laurel asks, how dangerous is occasional A flutter?
Dr. Sung: If you have atrial flutter, the likelihood that it goes away on its own is very low. Now in some rare cases it may just pop up once and go away. What we know, at least from current data, is that when you have atrial flutter, you're also at risk of stroke and some of the similar issues that patients with atrial fibrillation face. The other thing, generally speaking about atrial flutter, is that the heart rate tends to also go very fast when you have it and when you have fast heart rates over a long period of time, that also can do damage, not just to the top part, the atria, but also to the bottom part, the ventricle, that can lead to some bigger problems.
Dr. Sung: Everyone is different. That's the reason why there is some difficulty in answering that question. A lot of it depends on how fast does your heart go? How much atrial fibrillation are you having? What are your individual risk factors for stroke? Et cetera. The good thing about atrial flutter is that it's acutely curable with a relatively simple procedure. This electrophysiology study and ablation, as long as it's what we call the typical form of atrial flutter. There are other rare cases of what we call atypical flutter that are much more difficult to manage.
Dr. Sung: Overall recommendation is that if I does bother you, you have issues related to atrial flutter, may not be a bad idea to see an electrophysiologist to potentially consider getting a cure.
Alyssa Paschke: Great. Well thank you everyone in the audience who watched and for asking really great questions. I hope this was informative as it was for me learning about this condition. If any questions come up after you've seen this video, feel free to type them in the comments and we'll get them over to Dr. Sung to answer.
Alyssa Paschke: Thanks so much again for joining us and if you'd like any more information or news from National Jewish Health, feel free to visit our website at www.njhealth.org. Thanks.
Dr. Sung: Thank you.
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