According to the federal Center for Disease Control and Prevention, between 2.7 and 6.1 million Americans have atrial fibrillation (AF). AF starts as an irregular and rapid heart rhythm in the upper chambers of the heart. The rhythm change may begin slowly but becomes stronger and more constant as time goes on. AF doesn't always have symptoms. Many people don't even know they have it.
Listen in as Kanwaljit Gill, MD, a board certified cardiologist and a member of the medical staff at Palmdale Regional Medical Center, discusses atrial fibrillation and how, with treatment, you can have a better quality of life.
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Atrial Fibrillation: Palmdale Regional Medical Center Can Help
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Learn more about Kanwaljit Gill, MD
Kanwaljit Gill, MD
Kanwaljit Gill, MD is a a board certified cardiologist and a member of the medical staff at Palmdale Regional Medical Center.Learn more about Kanwaljit Gill, MD
Transcription:
Melanie Cole (Host): According to the Federal Center for Disease Control and Prevention, up to 6 million Americans may have atrial fibrillation. My guest today is Dr. Kanwaljit Gill. He’s a cardiologist and a member of the medical staff of Palmdale Regional Medical Center. Welcome to the show, Dr. Gill. So first, tell us a little bit of physiology. What is atrial fibrillation?
Dr. Kanwaljit Gill (Guest): Well, atrial fibrillation is an irregular and often rapid heart rhythm that occurs in about 5 to 10 percent of patients above 60 years. During atrial fibrillation, the heart, which has two upper chambers called the “atria”, starts beating chaotically and irregularly and they beat out of coordination with the lower chambers, which are the ventricles of the heart.
Melanie: So, would somebody know? Is this something you can feel if it’s happening?
Dr. Gill: It’s something that a lot of patients can feel but there are some groups of patients that do not have any symptoms from atrial fibrillation and that present with signs of strokes or blood clots going to other organs in the body which becomes an emergency. Most of the time the signs, or symptoms, I should say, that patients complain about are shortness of breath. They feel their heart pounding. They feel tired and fatigued when they walk or do any exercise, and sometimes they feel lightheaded or dizzy. Those are typically the most common symptoms that patients complain about when they go into atrial fibrillation.
Melanie: Dr. Gill, who’s at risk from A-fib?
Dr. Gill: Well, mostly A-fib is seen as patients grow older, and it occurs more in people that have underlying heart disease, mostly blood pressure, blockages in the heart arteries, abnormal heart valves, or, if they have underlying lung disease. Even thyroid disease can cause this. People that have a history of smoking or use too much caffeine or stimulants or alcohol. They are predisposed to getting atrial fibrillation. Sleep apnea, which is one of the common causes of atrial fibrillation, often is not very well-recognized by both the patients as well as the physicians and it becomes a very important risk factor for people to develop atrial fibrillation or flutter.
Melanie: Dr. Gill, since many heart problems have similar warning signs and symptoms, what is something that you would tell patients about when to really seek treatment because even some of the symptoms you mention can mimic anxiety and stress and panic attacks.
Dr. Gill: That’s exactly right. And what I tell patients mostly is that they need to do periodic blood pressure and pulse rate checks and any time, if they feel that they are not feeling good, and this may not require them to go to the hospital, but just to check their blood pressure, pulse rate, and discuss with their primary care physicians or cardiologist about these symptoms early on, and it may require a simple EKG to rule out whether this is anxiety-related palpitations or shortness of breath or symptoms that they are getting, or is it some sort of true arrhythmia that is causing it. A lot of times, this also can be episodic where it’s not continuous and the doctors may like to do certain tests, like a Holter monitor or an event monitor which they can wear for 24, 48 hours, or sometimes up to 2 weeks, to catch these arrhythmias when they happen.
Melanie: What’s the first line of defense and the treatments that you recommend if you do detect atrial fibrillation in someone?
Dr. Gill: When you detect atrial fibrillation, typically there are a few things that are going on. Number one is the heart rate typically goes from 100 to 170 beats per minute, so the first thing that we try to do is control their heart rate, bring it closer to normal – 70’s, 80’s, 90’s-- if we can. There are certain medicines that slow the heart rate down. At the same time, we assess the risk of blood clots that can develop in these patients and there are certain groups of patients that are more prone to developing these blood clots that can go out of the heart and lodge into the brain and cause a stroke or go down into the legs and stop the circulation in the legs, or go, actually, to any organ in the body, including your gut, your kidneys, and can cause major, major issues there. So, in patients we quickly assess their risk of developing those complications and if we find that they are at risk, we try to put them on blood thinning medicines which lower the risk of them developing those complications.
Melanie: So, if they’re on blood thinning medication to reduce the risk of those complications, is this something they’re going to have to take for the rest of their lives?
Dr. Gill: It depends on an individual. There are certain patients where this atrial fibrillation happens fairly quickly and you catch it fairly early in the course of the disease. A lot of times, you can prevent putting them on long-term medications by either keeping them on medicine that will control the rate and the rhythm, mostly the heart rhythm where you try to keep them in normal sinus rhythm, which is the normal heart rhythm, and if you are confident that these patients are maintaining normal rhythm, then you can take them off of blood thinning medicines. Older folks, sometimes, and those that have a lot of other what we call “co-morbidities” – high blood pressure and diabetes and prior history of stroke and congestive heart failure, or blockages in their heart arteries or blockages in their vascular system in the legs-- they are at great risk for those complications. Those patients, we make sure before we take them off of these blood thinners, that they are not going in and out of atrial fibrillation. A lot of times people may not feel when they go into atrial fibrillation and even short episodes of atrial fibrillation that may not go noticed can lead to those complications that we alluded to earlier.
Melanie: Are there some surgical interventions that might be necessary?
Dr. Gill: In some patients, we do send them for what we call “electrophysiology consultations”, where there are certain procedures that are catheter-based, where catheters can be inserted into the heart chambers and, using controlled energy, they can either freeze or heat up certain areas of the heart tissue where these irregular heartbeats are more prone to start. By that, you can eliminate atrial fibrillation--not 100 percent but at up to 70 percent of the time. So, the success rate for those procedures may not be that high, and it all depends on what their risk factors are. Like we talked about, the older patients, they have a history of weak heart muscle or they have congestive heart failure and it’s less likely for these procedures to work. But, there are a whole bunch of patients that would be excellent candidates for those, and we do screen those patients and send them for those procedures and they can get off of the all the medicines that we use, like blood thinners or medicines to slow the heart down. They can potentially get off of those once there is success with these procedures.
Melanie: So, in just the last few minutes, Dr. Gill, what should patients with A-fib be thinking about when seeking care, and what do you want them to know about lifestyle – behaviors, modifications, anything they can do to help the situation.
Dr. Gill: Well, like any other heart disease, I tell them that they need to stick with heart-healthy foods. Eat more vegetables, fruits, whole grains; exercise regularly. Physical activity helps not only the risk of getting heart disease, that is, coronary artery disease or blocked arteries, but it also helps the electrical system of the heart. Smoking – if somebody is a smoker, I ask them to quit smoking. Alcohol, like I said earlier, alcohol in moderation. One drink a day for a woman and men older than 65, and up to two drinks for men less than age 65. Also, I tell them to keep a record of their blood pressure and heart rate and monitor those on a periodic basis--not to overdo it, but to check it on a regular basis. Of course, sleep apneas are very common in people that are overweight and losing weight is one of the main things that help lower the risk of sleep apnea and, hence, atrial fibrillation. Of course, follow up with doctors on a regular basis if you have been diagnosed with A-fib so that they can be prescribed the correct medicines when we catch these arrhythmias. That’s what I recommend to patients.
Melanie: And why should they come to Palmdale Regional Medical Center for their care?
Dr. Gill: Well, we have a very good cardiovascular team and all the doctors and we have good support. Nursing support is excellent. We have great dietitians, dietary support and we are, basically, doing what is being done and has been proven in all the big studies in the country.
Melanie: Thank you so much for being with us today, Dr. Gill. It’s such important information. You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, you can go to palmdaleregional.com. That’s palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): According to the Federal Center for Disease Control and Prevention, up to 6 million Americans may have atrial fibrillation. My guest today is Dr. Kanwaljit Gill. He’s a cardiologist and a member of the medical staff of Palmdale Regional Medical Center. Welcome to the show, Dr. Gill. So first, tell us a little bit of physiology. What is atrial fibrillation?
Dr. Kanwaljit Gill (Guest): Well, atrial fibrillation is an irregular and often rapid heart rhythm that occurs in about 5 to 10 percent of patients above 60 years. During atrial fibrillation, the heart, which has two upper chambers called the “atria”, starts beating chaotically and irregularly and they beat out of coordination with the lower chambers, which are the ventricles of the heart.
Melanie: So, would somebody know? Is this something you can feel if it’s happening?
Dr. Gill: It’s something that a lot of patients can feel but there are some groups of patients that do not have any symptoms from atrial fibrillation and that present with signs of strokes or blood clots going to other organs in the body which becomes an emergency. Most of the time the signs, or symptoms, I should say, that patients complain about are shortness of breath. They feel their heart pounding. They feel tired and fatigued when they walk or do any exercise, and sometimes they feel lightheaded or dizzy. Those are typically the most common symptoms that patients complain about when they go into atrial fibrillation.
Melanie: Dr. Gill, who’s at risk from A-fib?
Dr. Gill: Well, mostly A-fib is seen as patients grow older, and it occurs more in people that have underlying heart disease, mostly blood pressure, blockages in the heart arteries, abnormal heart valves, or, if they have underlying lung disease. Even thyroid disease can cause this. People that have a history of smoking or use too much caffeine or stimulants or alcohol. They are predisposed to getting atrial fibrillation. Sleep apnea, which is one of the common causes of atrial fibrillation, often is not very well-recognized by both the patients as well as the physicians and it becomes a very important risk factor for people to develop atrial fibrillation or flutter.
Melanie: Dr. Gill, since many heart problems have similar warning signs and symptoms, what is something that you would tell patients about when to really seek treatment because even some of the symptoms you mention can mimic anxiety and stress and panic attacks.
Dr. Gill: That’s exactly right. And what I tell patients mostly is that they need to do periodic blood pressure and pulse rate checks and any time, if they feel that they are not feeling good, and this may not require them to go to the hospital, but just to check their blood pressure, pulse rate, and discuss with their primary care physicians or cardiologist about these symptoms early on, and it may require a simple EKG to rule out whether this is anxiety-related palpitations or shortness of breath or symptoms that they are getting, or is it some sort of true arrhythmia that is causing it. A lot of times, this also can be episodic where it’s not continuous and the doctors may like to do certain tests, like a Holter monitor or an event monitor which they can wear for 24, 48 hours, or sometimes up to 2 weeks, to catch these arrhythmias when they happen.
Melanie: What’s the first line of defense and the treatments that you recommend if you do detect atrial fibrillation in someone?
Dr. Gill: When you detect atrial fibrillation, typically there are a few things that are going on. Number one is the heart rate typically goes from 100 to 170 beats per minute, so the first thing that we try to do is control their heart rate, bring it closer to normal – 70’s, 80’s, 90’s-- if we can. There are certain medicines that slow the heart rate down. At the same time, we assess the risk of blood clots that can develop in these patients and there are certain groups of patients that are more prone to developing these blood clots that can go out of the heart and lodge into the brain and cause a stroke or go down into the legs and stop the circulation in the legs, or go, actually, to any organ in the body, including your gut, your kidneys, and can cause major, major issues there. So, in patients we quickly assess their risk of developing those complications and if we find that they are at risk, we try to put them on blood thinning medicines which lower the risk of them developing those complications.
Melanie: So, if they’re on blood thinning medication to reduce the risk of those complications, is this something they’re going to have to take for the rest of their lives?
Dr. Gill: It depends on an individual. There are certain patients where this atrial fibrillation happens fairly quickly and you catch it fairly early in the course of the disease. A lot of times, you can prevent putting them on long-term medications by either keeping them on medicine that will control the rate and the rhythm, mostly the heart rhythm where you try to keep them in normal sinus rhythm, which is the normal heart rhythm, and if you are confident that these patients are maintaining normal rhythm, then you can take them off of blood thinning medicines. Older folks, sometimes, and those that have a lot of other what we call “co-morbidities” – high blood pressure and diabetes and prior history of stroke and congestive heart failure, or blockages in their heart arteries or blockages in their vascular system in the legs-- they are at great risk for those complications. Those patients, we make sure before we take them off of these blood thinners, that they are not going in and out of atrial fibrillation. A lot of times people may not feel when they go into atrial fibrillation and even short episodes of atrial fibrillation that may not go noticed can lead to those complications that we alluded to earlier.
Melanie: Are there some surgical interventions that might be necessary?
Dr. Gill: In some patients, we do send them for what we call “electrophysiology consultations”, where there are certain procedures that are catheter-based, where catheters can be inserted into the heart chambers and, using controlled energy, they can either freeze or heat up certain areas of the heart tissue where these irregular heartbeats are more prone to start. By that, you can eliminate atrial fibrillation--not 100 percent but at up to 70 percent of the time. So, the success rate for those procedures may not be that high, and it all depends on what their risk factors are. Like we talked about, the older patients, they have a history of weak heart muscle or they have congestive heart failure and it’s less likely for these procedures to work. But, there are a whole bunch of patients that would be excellent candidates for those, and we do screen those patients and send them for those procedures and they can get off of the all the medicines that we use, like blood thinners or medicines to slow the heart down. They can potentially get off of those once there is success with these procedures.
Melanie: So, in just the last few minutes, Dr. Gill, what should patients with A-fib be thinking about when seeking care, and what do you want them to know about lifestyle – behaviors, modifications, anything they can do to help the situation.
Dr. Gill: Well, like any other heart disease, I tell them that they need to stick with heart-healthy foods. Eat more vegetables, fruits, whole grains; exercise regularly. Physical activity helps not only the risk of getting heart disease, that is, coronary artery disease or blocked arteries, but it also helps the electrical system of the heart. Smoking – if somebody is a smoker, I ask them to quit smoking. Alcohol, like I said earlier, alcohol in moderation. One drink a day for a woman and men older than 65, and up to two drinks for men less than age 65. Also, I tell them to keep a record of their blood pressure and heart rate and monitor those on a periodic basis--not to overdo it, but to check it on a regular basis. Of course, sleep apneas are very common in people that are overweight and losing weight is one of the main things that help lower the risk of sleep apnea and, hence, atrial fibrillation. Of course, follow up with doctors on a regular basis if you have been diagnosed with A-fib so that they can be prescribed the correct medicines when we catch these arrhythmias. That’s what I recommend to patients.
Melanie: And why should they come to Palmdale Regional Medical Center for their care?
Dr. Gill: Well, we have a very good cardiovascular team and all the doctors and we have good support. Nursing support is excellent. We have great dietitians, dietary support and we are, basically, doing what is being done and has been proven in all the big studies in the country.
Melanie: Thank you so much for being with us today, Dr. Gill. It’s such important information. You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, you can go to palmdaleregional.com. That’s palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.