- Hey, I'm Dr. Morales,
And thanks for checking out this video.
In this video, I'm gonna discuss AFib with RVR.
I'm gonna discuss what that means,
what is the significance of it, how it feels,
and ultimately how it's treated as well.
Make sure you stick around to the end
because I'm gonna discuss ways in which I can help you
with AFib with RVR, no matter where you live.
So what is AFib with RVR?
You may have gotten some paperwork either
from your doctor's office or from the hospital
and it says you were diagnosed with AFib with RVR.
And what does that really mean?
So first for the actual term itself.
AFib, of course, means atrial fibrillation
but then RVR stands for rapid ventricular rate.
That's basically a fancy medical way
to say that your heart was going fast.
And most people, not everybody,
but most people who have AFib,
the heart rate actually tends to go very fast.
So if your heart rate was going faster
than 100 beats per minute, you would be called
that you had AFib with RVR,
as opposed to AFib with controlled ventricular rate or CVR,
means that your heart rate is under a hundred,
usually between 60 and a hundred.
And it's the occasional people who have AFib
with slow rates, which are less than 60,
that would be slow ventricular rate.
But the grand majority of people have AFib with RVR
when they're having episodes of AFib,
especially when the episodes come and go.
When you get into AFib, that heart rate shoots up
to well over a hundred beats per minute.
So AFib with RVR, as you would imagine,
basically feels like your heart rate's going very fast.
The atria in AFib with RVR are actually going very fast.
The upper parts of the heart
which are where the atria comes from, they fib
with usually going well over 600 beats per minute.
Fortunately, the pulse, the one that you can detect
and feel and check for, actually comes from the ventricles
which is the bottom part of the heart.
And fortunately the ventricles don't usually go that fast,
as fast as the atria are going during AFib with RVR,
but they can go very rapid.
They not uncommonly to be between 120 and 150,
and there are some cases where it gets really, really fast,
goes 180 close to 200 beats per minute.
And so some people can become extremely rapid
when they get atrial fibrillation with RVR.
So what does that actually feel like?
What does it feel like to have AFib with RVR?
Well, the most common feeling would be
that your heart rate just starts going really fast.
For most people, who are not in AFib all the time,
they maybe have a nice, steady, normal heartbeat
in the normal rhythm of about 60 to 70 beats per minute,
then all of a sudden that heart rate goes up
and it goes real fast.
And it just... some people say that it feels
like their heart just like explodes
and just starts going very fast,
even though you're not really doing anything at that time.
You're not exercising or doing anything
that would naturally give you a fast heart rate.
And all of a sudden goes very fast,
described as a very fast, pounding heart rate.
Sometimes it can skip and stutter a little bit,
and some people describe it as a fish flopping,
it's, kind of, just all over the place
and it's not really going steady fast,
but it's, kind of, going fast and slow,
fast and slow, fast and slow.
So those are common ways that people can feel AFib with RVR,
but some people just don't necessarily feel
that heart rate going fast.
Some people just may feel very dizzy or lightheaded
because of the lack of circulation or blood flow
to your brain because your heart's going so incredibly fast.
Or sometimes people may feel just, kind of, tired
because of just that lack of energy, kind of,
the way you're tired after you exercise
or your heart's going really fast.
You can just have... feel tired feeling.
Some people may feel very short of breath.
And that's, kind of, that shortness of breath
is actually your symptom of your AFib with RVR,
even though it's not necessarily the heart rate going fast,
and you feel it's just that shortness of breath
because their heart's going so fast.
And then, of course, there's also people
who feel absolutely nothing.
So there's some people who have AFib with RVR
and they couldn't tell you at all that they were having it.
And it's just, kind of, found incidentally,
when you go into either a doctor's office
or you have a heart monitor put in and you're noticing
that you're getting these episodes of AFib with RVR.
So how is AFib with RVR treated?
Let's talk about in the short term treatment
for AFib with RVR.
Short term, the main way is to reduce the heart rate.
And especially if you're in the emergency room setting
or in a hospital setting, and you're showing up
with your heart rate going extremely fast, 120 or above,
most likely you'll be getting intravenous medications
to slow your heart rate down,
which is usually step number one.
The most commonly used medications
in the emergency room setting would likely
be intravenous Metoprolol or Cardizem,
which are both blood pressure medications
which tend to slow the heart rate down.
And they work pretty quickly
and they're very good medications to use.
However they can affect blood pressure,
they are blood pressure medications as well.
So there are some people who show up
that the heart rate is so fast that their blood pressure
is actually compensating and very low.
And so your blood pressure may be
in the low nineties or low one hundreds,
and a lot of times these normally used medications
like Metoprolol or Cardizem are just too strong
and it's gonna make that blood pressure get even lower.
And so they usually not a good option
for somebody who is rapid heart rate,
as well as a very low blood pressure.
In those settings, other intravenous options
can be a medication called Digoxin,
which is an intravenous medication
which can slow the heart rate down.
It does take a little while to kick in usually
about a few hours to really notice an effect
from the intravenous Digoxin.
And, but the one, the most commonly ones used,
especially in a hospital setting or emergency setting,
would be intravenous Amiodarone.
Amiodarone is a medication
that will slow your heart rate down
and can potentially convert somebody
out of a defibrillation as well.
And it doesn't really affect blood pressure very much.
And that's why it's probably the most commonly used
in the emergency room setting or hospital setting
because it's given intravenously, slows the heart rate down.
It really doesn't affect blood pressure.
And in a short term setting,
it can actually be a very useful medication.
I use it quite a lot in hospital patients.
However, long term, many of you may know that Amiodarone
is associated with a lot of long-term use side effects.
And so even though people may be discharged
with it in pill form, usually after a few weeks or so,
I'm working to try to get somebody off of that medication.
But when you have AFib with RVR and you're in the hospital,
intravenous Amiodarone is probably one
of the most commonly used medications.
So those four medications are used
to control the heart rate and slow it down.
The Amiodarone, however,
that can also potentially convert AFib
and actually stop it completely as well,
since is it more of a antiarrhythmic type of medication.
There are other antiarrhythmic medications as well
that can be used,
but they're mostly all otherwise in pill form.
Other medications, such as Flecainide, Sotalol, Dofetilide,
these can all be used
and potentially stop atrial fibrillation episodes,
particularly Flecainide can be used as a pill at home
that can actually help stop AFib with RVR episodes.
It's actually a technique and strategy
called pill in a pocket where you would actually take
a high dose of Flecainide, usually about 150 milligrams,
or up to 200 milligrams at one time
and see if it can actually stop your AFib episode.
So the goal is not to necessarily slow down the AFib
as it is with some of the other intravenous medications
but to actually potentially stop the episode of AFib.
And, but always check with your doctor to see
if that's a safe strategy with you to use
for your AFib with RVR.
In addition, there's even some strategies
that you can even do at home
that can stop episodes of AFib with RVR.
Probably one of the most commonly one used would be
what's called vagal maneuvers.
Vagal maneuvers are when you try
to activate your vagus nerve
which is, helps to slow your heart rate down.
One of the most common ones used would be
what's called a valsalva maneuver.
A valsalva maneuver is where you try to basically bear down,
and while you're holding your breath, kind of, like
what you're have when you're having a bowel movement,
but it can rapidly stop some arrhythmias including AFib.
So you basically will just take a deep breath
and push down, kind of, like you're having a bowel movement
and just see if you can hold it as long as you can,
and see if that can stop an AFib episodes.
Other ways of slowing your heart rate down
would be carotid massage.
If you have AFib with RVR, carotid massage is where
you basically try to rub your carotid neck.
There's actually another, a great lot of inputs
for the vagus nerve, right around here,
where you feel the most pulse
of the carotid artery right here,
right next to is where all the nerves are.
And you basically just, kind of, push down on it
and massage it for a good minute or so.
You can also alternate and go to the other side as well.
But don't do both at the same time, of course.
Yeah, but do one and then you can always try
the other one as well.
That can also slow your heart rate down as well.
Other things you can do at home for AFib with RVR,
actually include yoga and breathing exercises,
but mostly geared towards ones
that are more relaxation breaths.
So try taking deep breaths.
There are a lot of great relaxation-based yoga instructors
on YouTube that, kind of, give you nice,
long breathing exercise ways to relax
and help us try to slow your heart rate down.
Another interesting one is called a divers reflex.
And a divers reflex is basically when you put your face
in something extremely cold, like a bucket of cold water,
and you just submerge your face in that really cold water.
And that can actually activate your vagus nerves as well,
and slow your heart rate down.
Another way that you can potentially treat AFib with RVR
at home would actually be to exercise.
And this is actually something that I'm not
a hundred percent sure how it works,
but I've had countless patients that do it.
So obviously make sure that you're somebody
who can actually exercise on a normal basis.
But I've had people who'll say,
"Oh, I get over the AFib with RVR,
if I go for a run or go up down downstairs,
something that's really, really strenuous cardiovascularly,
it will stop my AFib episodes.
And so I've had quite a few people
who have been successfully able to terminate
their AFib with RVR episodes like that.
And so those are the ways
you can potentially stop AFib episodes at home,
or as well as how they treat it
in the emergency room as well.
Obviously long term, you know,
you don't wanna have AFib with RVR episodes.
So there's many ways that you can treat AFib
and, in the bigger picture, to try to prevent
and minimize episodes of AFib with RVR.
Medications are always options.
There are pill forms of either beta blockers
or even antiarrythmic medications,
which can be great for some patients.
They can help reduce the amount of AFib with RVR episodes
that you're having.
In addition, procedures can be helpful as well.
Procedures such as a cardioversion shock
which can be useful in the short term.
Like if you're in the hospital and your AFib
is not going away, you may be able to do a cardioversion
which is an electrical shock of your heart
to help reset your heart and get you out of AFib with RVR.
But the long term ablation procedures
can be a very good option to reduce
how much AFib you're having.
In an ablation procedure,
a doctor like myself does strategic burn marks
in the left upper chamber of your heart
which is where most AFib comes from.
And that long term can certainly reduce
how much AFib episodes that you're having.
In addition, lifestyle modifications, including weight loss,
removing artificial ingredients, removing preservatives,
keeping your food as natural as possible,
reducing and minimizing alcohol.
All these lifestyle modifications can play a crucial role
to improve and reduce episodes of AFib with RVR,
which is why I created the Take Control Over AFib Program.
The Take Control Over AFib Program is my own video course
where I give you you a step by step plan and guide
to help you apply all the things, lifestyle wise,
into your life to help improve
and reduce atrial fibrillation.
So right underneath this video, there's gonna be a link
to the Take Control Over AFib Program.
We can learn more about the program, learn more
about what's included, as well as see testimonial videos
of people who have actually signed up and taken the program.
See what they have to say,
and see if it's the right option for you.
But I wish you the best with your AFib
and hopefully with these tips
you can help reduce your AFib with our RVR episodes.