Dr. Maheer Gandhavadi joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about atrial fibrillation.
Read the transcript of Dr. Ganhavadi's talk on Health Matters radio or listen here
Dr. Gandhavadi: Atrial fibrillation. So, normally, when our heart beats there are two chambers, basically…the top chambers and the bottom chambers, and they kind of work together, and the top chamber feeds blood into the bottom chamber, and it's always squeezing nice and regularly. But, what happens in atrial fibrillation is you have basically electrical disorganization in the top part of the heart. Instead of squeezing regularly, that top part of the heart starts to shake kind of uncontrollably, and it can make the bottom part of the heart confused and the bottom part of the heart can beat irregularly or very rapidly. Atrial fibrillation is a very common abnormal heart rhythm. It is estimated that anywhere from 3 to 6 million people in the United States have this arrhythmia, and by 2050 it's estimated that up to 12 million people will have this.
Health Matters: Why does this happen?
Dr. Gandhavadi: That's a great question. We don't really know. We know that there are a lot of different risk factors, people who have diabetes. As you get older, if you have high blood pressure, that increases your risk of atrial fibrillation, but why some people get it and some people don't we are still trying to figure out.
Health Matters: Interesting. I read something the other day that a lot of people that we hear, we would call it a heart attack or sudden cardiac arrest, I mean, is it true that a lot of these people may have arrhythmias, like an atrial fibrillation that causes the heart problems and that's what they actually pass away from?
Dr. Gandhavadi: Cardiac arrest refers to a really disorganized beating of the bottom part of the heart, and atrial fibrillation is disorganization of the top part of the heart. So atrial fibrillation shouldn't lead to cardiac arrest or death. The biggest risk that we worry about with atrial fibrillation is that it increases your risk of stroke.
Health Matters: And, tell us why that is.
Dr. Gandhavadi: Well, the top part of the heart normally squeezes regularly, and that pushes all the blood out of the top chambers. But, in atrial fibrillation the top part of the heart is just kind of quivering and so blood kind of sits in those chambers and it can form blood clots. Anytime blood sits somewhere you get blood clots, and these blood clots can then go to different parts of your body, like your brain, and cause a stroke.
Health Matters: So, just from a physiological standpoint, so our listeners really understand, so you're talking about these chambers and the top part basically, the atrium, pushes blood into the lower part, which we call the ventricle, and it's important that that ventricle gets full and it needs to be filled up with blood in order to pump blood into our extremities.
Dr. Gandhavadi: That's true, and part of the problem with atrial fibrillation is sometimes you can have a very rapid heart rate as a result of it and that can make it difficult for the bottom chambers to fill appropriately and to really pump out enough blood.
Health Matters: Now, I'm already regretting asking this question because I am going to probably feel like this for the next few weeks. What are the symptoms? What are you feeling when you have this?
Dr. Gandhavadi: Often, people will feel an irregular or racing heartbeat, and the thing about atrial fibrillation is it can kind of come and go, so sometimes you will feel an irregular fluttering in your chest that lasts for a few seconds or a few minutes, and then it goes away. Other times you feel it, and it can just come on and stay on. Now, there are other folks in whom it has more of, a more insidious effect. And, instead of feeling fluttering or a racing heartbeat, what they actually feel is that they suddenly become short of breath, or a lot more tired, or they just don't have enough energy.
Health Matters: But, does that happen, you know, as you think you're having a heart attack, don't you get short of breath and, (gasp), and all that kind of stuff going on?
Dr. Gandhavadi: Yes, and with a heart attack what we really worry about is that you start to feel chest discomfort or short of breath at rest. With atrial fibrillation, it's really people mostly notice this when they start to do something, when you get up and start to walk, "Well, gee, now I'm short of breath. That never happened before." That could be a subtle sign that you are dealing with atrial fibrillation.
Health Matters: You talked about some risk factors, and one of them was diabetes and high blood pressure. Is there a genetic component, a male versus female component, age component? I mean, give us some of the risk factors.
Dr. Gandhavadi: There have been some genetic components that affect atrial fibrillation, but for the most part it's not really a genetic condition that's passed on from one person to another. Really, it's high blood pressure, if you're a smoker, if you have diabetes, if you're obese. All those things increase your risk of atrial fibrillation. In terms of gender, men actually are at higher risk of developing atrial fibrillation, but women, for whatever reason, are at a higher risk of getting strokes from atrial fibrillation.
Health Matters: Then, your specialty, you are a cardiologist, but your specialty is electrophysiology, so this is what you do on a daily basis is try to diagnose, identify what's causing these arrhythmias, and what's the intervention if someone has atrial fibrillation and needs some kind of help? What are the medical options?
Dr. Gandhavadi: If you start feeling irregular beats, the first thing you should do is talk to your primary care physician, and then they can do simple things like an EKG or a monitor to try and see if you may be having atrial fibrillation. If you do have atrial fibrillation, as we talked about earlier, the biggest thing we worry about is the risk of stroke. If you do have atrial fibrillation then your doctor may put you on blood thinners to reduce your risk of stroke. There are some people who are symptomatic and really uncomfortable when they are in atrial fibrillation, and, if that's the case, there are medicines and procedures that we can do to try and keep you in a normal rhythm.
Health Matters: Out of all those people that have it and are diagnosed, what percentage can just take oral medication, for example, and what percentage need some kind of procedure and maybe seek your advice or intervention?
Dr. Gandhavadi: I would say that most people can get by on simply an oral medication to keep their heart rate under control and to reduce their stroke risk, and that fewer people feel very symptomatic. But, it can be very subtle, and so some people say, "I feel great." But, when you get down to it, they say, "Well, I can't really do everything that I was able to do a year ago or two years ago, but I still feel pretty good," and that's just a subtle sign that they are having trouble because of this atrial fibrillation.
Health Matters: Then, when they seek your attention are you going to put a pacemaker in, are you going to do things to correct the electrical impulses going from the top of the heart down to the lower part of the heart, then? Does this happen after the step #1 of medication? Is there, like, a second step?
Dr. Gandhavadi: Right. So, no matter who you are, if you have atrial fibrillation the first thing you need is to be on a blood thinner. Once you're on a blood thinner, then what we try and determine whether you're having symptoms, does this affect your quality of life? And, if it does affect your quality of life, then there are medications that we can use, antiarrhythmic medications, to keep you in a normal rhythm. If those don’t work, then there are small, minimally invasive procedures that we can do to basically target the areas on your heart that are responsible for the AFib and prevent the AFib from coming back. Most people with AFib don't need a pacemaker. A pacemaker supports your heart rate when it's too slow, but it can't prevent you from going into atrial fibrillation.
Health Matters: Dr. Maheer Gandhavadi, thanks so much for comin on with us.