Welcome to Medicine with Dr. Moran. I'm Dr. Keith Moran.
Today I'm going to talk about preventing episodes of Atrial Fibrillation.
Atrial Fibrillation is the most common heart rhythm abnormality that patients have.
Several years ago medical evidence became available to support lifestyle changes to reduce
the frequency of atrial fibrillation. I created a patient information sheet which I've been giving
out to all my patients with atrial fibrillation. On it essentially is all of the information that
I'm going to present in this video. Now atrial fibrillation is called Paroxysmal in many patients
because it comes and goes. The word paroxysmal actually means intermittent. As I mentioned this
is the most common heart rhythm disorder and it increases as people get older. As you can
see only about one in a thousand will have this before the age of 55. Now when you look at people
who are much older particularly people over the age of 80 it's present in about 20% of patients.
The symptoms that some people can get with atrial fibrillation these can be quite varied
as you can see from the slide. Some patients are asymptomatic when they go into atrial fibrillation
and they do not notice it at all. This tends to occur in older people more but not always.
Most younger patients will have symptoms and can often note the exact onset of atrial fibrillation
as well as when the atrial fibrillation stops. The most common symptoms when people do have it from
atrial fibrillation are palpitations. Patients feel their heart pounding in their chest or racing
very quickly. It's often more noticeable when they're lying in bed and not moving.
It is at this time patients can feel the heart beating inside the chest.
It may be quite irregular it may be rapid and it may be a little uncomfortable in some people.
Now atrial fibrillation while it can be rapid can also be of normal speed if patients are
on medications for this or if they've got some slowing of their electrical fibers in the heart.
Other associated symptoms can include feeling lightheaded or dizzy patients may
note shortness of breath if they're doing an activity and the heart rate's rapid.
Next I'm going to talk about things that you can do to prevent episodes of atrial fibrillation.
Lifestyle or risk factor modification is very important in the management of this condition.
Adherence to these recommendations can markedly reduce the frequency
of atrial fibrillation. Often these lifestyle changes which can be accomplished quite easily
can be better than actually taking a rhythm drug to prevent atrial fibrillation.
Rhythm drugs are called Antiarrhythmics but all of them do have side effects and it's obviously
better to make lifestyle modifications rather than to take rhythm medications. There have
been many studies which show that the following lifestyle changes will reduce the frequency or
attacks of atrial fibrillation. Unfortunately it will not prevent every single episode.
This slide has the lifestyle recommendations that are helpful at reducing the frequency of
atrial fibrillation these include achieving a normal weight, regular physical exercise,
treatment of sleep apnea if you have it, optimization of cholesterol values,
normalizing your blood pressure if elevated, reducing your salt intake,
achieving optimal glucose control avoiding stimulants, reducing emotional stress or anxiety,
or treating any underlying structural heart disease smoking cessation can be helpful as well.
In the next few slides I will review each recommendation one at a time.
The first one is weight management. You need to achieve a normal body mass index
a normal body mass index or BMI should be in the 18.5 to 25 range.
The BMI is easily computed by taking your weight in kilograms and dividing by your height in meters
squared. There are many body mass indicators online for you to compute your BMI. Everyone
should know their BMI. I have a separate video on how to calculate this as well as what it means.
There are many animal experiments demonstrating that increasing weight correlates with more atrial
fibrillation episodes and longer episodes of atrial fibrillation.
Weight loss surgery otherwise known as bariatric surgery produces benefits in atrial fibrillation
reduction. A Swedish study of 2,000 patients who underwent bariatric surgery were matched
to a similar number of obese control subjects and the risk of new atrial fibrillation was 29% lower
in the surgery group. In the legacy trial with patients who lost and maintained a weight loss of
more than 10% had a six-fold increase in freedom from atrial fibrillation and that was compared
to people who lost less than 3% of weight. I should mention that patients with a very low
body weight such as BMI of less than 18.5 in fact have a higher likelihood of atrial fibrillation.
Next is regular physical exercise. Achieving 10,000 steps per day if you have a fitness
tracker or phone that can monitor this would be one way for you to document your regular exercise.
Other ways is trying to achieve the three to five hours of moderate intensity exercise each week.
Moderate intensity is similar to brisk walking. It would include chores such
as pushing the lawn mower, bringing wood in, snow shoveling, and so on.
Regular exercise has been shown in the cardio fit study to reduce atrial fibrillation burden.
Even mild improvements in exercise capacity were associated with a two-fold greater freedom from
atrial fibrillation. Other types of exercise can also be helpful. In the three months Yoga My Heart
study there was reduced atrial fibrillation burden as well as improvement in several
different domains of quality of life. So mind body exercises such as Yoga or Tai Chi as well
as other exercises such as balance training and muscle strengthening can also be helpful.
Moving on to Obstructive Sleep Apnea. This is present in many people with atrial fibrillation.
Medical evidence in observational studies suggest a clear relationship
between severity of sleep apnea and episodes of atrial fibrillation.
Treating sleep apnea reduces the episodes of atrial fibrillation.
Now let me tell you obstructive sleep apnea is a condition which is caused when the breathing
passageway in the back of the throat is narrow during sleep snoring occurs
with mild or moderate narrowing but when the passageway becomes more significantly narrowed
patients will stop breathing or will start gasping to get air in through the occluded airway.
They ultimately stop breathing which we call Apnea. In order for them to open up their
airway they have to shift from a deeper level of sleep to a much lighter level so that the muscles
that control the airway can open up the airway. This produces a type of sleep awakening which
patients will not usually remember. Ultimately as they drift back into a deeper phase of sleep
the airway occlusion occurs once again. This process can occur many times during the night
and so many with obstructive sleep apnea will wake up in the morning feeling very unrefreshed
because of the frequent sleep awakenings even though they don't notice that they have them.
This is because they've not achieved the prolonged deep sleep that their body needs and that memories
that are formed during these phases of deep sleep will not be ingrained. Obstructive sleep apnea is
common in obese individuals. All patients with atrial fibrillation should have a sleep test
to either rule the diagnosis out or to rule the diagnosis in of obstructive sleep apnea.
Treatment of obstructive sleep apnea will reduce episodes of atrial fibrillation.
CPAP is the treatment. A CPAP mask provides continuous positive airway pressure. That's
what the CPAP stands for, continuous positive airway pressure and it goes through the nose
down into the breathing passageway to splint and push and open up the airway throughout the night.
Depending upon the severity we use different amounts of positive pressure.
It's important to get seven or eight hours of quality sleep each night for your overall health.
I recommend consistent bedtime and wake up time every day including the weekend days.
Now next Cholesterol Values These should be measured and the targets for the LDL
is less than 2.5 in metric units or less than 100 in the imperial units.
Your Triglyceride level should be normal. If you're above these values you will need
to be treated ideally with diet first but if this is not successful a trial of medications.
Blood Pressure. This is associated with an increased risk of developing atrial fibrillation
if it's high. The blood pressure should be measured at home. I recommend to all my patients
to purchase a home blood pressure monitor. It's important to periodically check the value that you
get with your monitor at the same time either when you're at your doctor or a pharmacist checking.
Readings should be between five to ten points from your machine with what your doctor or nurse gets.
An ideal blood pressure should be less than 130 over 80. I do tell my patients
that patients typically will see a certain amount of variability in their numbers.
It's not uncommon to see patients that will get numbers between 115 and 140 for the systolic
number but the important thing is is that the average systolic reading be less than
130. Keeping a diary of blood pressure numbers can be helpful. A list of numbers with a column
for morning readings, another for afternoon, and one for evening readings can be helpful sometimes
because often the blood pressure does tend to vary during the day and we can change the timing
of blood pressure medications to smooth out any times where the blood pressure numbers are high.
If you're on several blood pressure medications it can be very helpful to make sure that at least
one of the medicine is taken in the evening so that it prevents the rise in blood pressure which
occurs in the early morning hours just before getting up. This has been shown in several
medical studies to be of benefit. Blood pressure values as I mentioned can vary plus or minus 15%
If your blood pressure is above 130 over 80 dietary interventions are tried first
followed by medications. For dietary interventions the most important thing
is that you avoid any processed food and that you eat a predominantly
plant-based type of diet with low salt. A Mediterranean diet is often recommended.
There have been specific diets for blood pressure the one that's often quoted as the DASH diet DASH.
Now this is from Hermann Cartoons. This is not how to take your blood pressure and pulse.
Moving on to salt intake. I recommend keeping salt intake below 3 grams per day.
It can be very helpful for you to count the amount of salt that you're currently getting
to see whether you're under this value or not. Diabetes this needs to be well controlled.
Diabetes is associated with a higher risk of atrial fibrillation.
Good control of glucose has been associated with reduced risk of atrial fibrillation.
Your three-month diabetic control test which is called the Hemoglobin A1C should be below 7%
This test measures how much glucose is bound to Hemoglobin. Hemoglobin typically lasts 3 months
in the bloodstream. Patients with high blood sugar will have more glucose attached to the
protein hemoglobin. A normal hemoglobin A1C value is less than 6% ideally in fact even 5.7% or lower
and values certainly under 6% indicate no evidence of diabetes. Hemoglobin A1C values in the 6 to
6.4% indicates pre-diabetes and numbers above 6.4% indicate that the patient is diabetic.
Optimal diabetic control generally is considered a number below 7% but to me
ideally the goal is to get the hemoglobin A1C below 6% and without diabetic medications.
This of course would indicate complete reversal of a diagnosis of diabetes.
This can be achieved through dietary means. A low carbohydrate diet can be extremely successful
at doing this carbohydrates are broken down in the intestine to glucose and obviously the less
consumption you have of carbohydrates the lower your blood glucose will be. Typically I recommend
50 grams of carbohydrates per day to give you an idea of what a low carbohydrate diet is.
Stimulants. Avoiding stimulants is very important at reducing the frequency of atrial fibrillation.
Stimulants can include caffeine, alcohol, recreational drugs, nasal decongestants,
as well as pharmaceutical medications. I recommend no more than one cup of coffee per day.
One can use decaf coffee, decaf tea, or decaffeinated other drinks.
Alcohol should be avoided with no more than one drink per day. Binge drinking with alcohol known
as the holiday heart syndrome is well known to precipitate episodes of atrial fibrillation.
This is something that I will see multiple times each year in younger people.
Emotional stress can also trigger episodes of atrial fibrillation. Adrenaline release
with emotional stress can trigger it as well. Good social supports with friends
family and pets are very helpful. Mindfulness and meditation can be helpful at stress reduction.
Next is Structural Heart Disease. This is something your physicians will help
you with. It's important that all aspects of your heart disease are managed optimally because they
will reduce the episodes of atrial fibrillation. Atrial fibrillation is associated with many
different kinds of heart disease including valve problems, coronary artery blockages,
heart muscle problems, heart failure, or other electrical system problems. Diseases
of the lining of the heart can also cause atrial fibrillation. Making sure that those problems
are optimally treated if you have them will reduce your likelihood of developing atrial fibrillation.
Smoking. Smoking cessation is important. This means cigars, cigarettes, marijuana,
vaping, nicotine products, and other tobacco products.
I often recommend keeping a diary of your atrial fibrillation. It can be very helpful
to record so that you have good information about your episodes writing down the dates,
how long the episodes last, any symptoms that you had, the heart rates while you're in atrial
fibrillation using your blood pressure machine, and of course any treatments that you took. Many
of my patients will bring in that data when they come to see me when I follow up with them about
their atrial fibrillation. This gives objective data to show me as well as your current doctors
how well things are going you can easily see how frequent the episodes occur and for how long.
So don't forget to bring this in when you see your doctor along with other parameters which
might include your blood pressure and pulse, at other times your weight and any changes in your
lifestyle that you've made. It makes it easier for your doctor to be able to manage your atrial
fibrillation and make the appropriate decisions on what we should be doing to control it.
Adherence to lifestyle modifications.
You do need to remember that even when patients adhere closely to all of the above recommendations
atrial fibrillation episodes while markedly reduced are not unfortunately completely
prevented. There does need to be regular close follow-up with your own physician in regards to
medications to manage this. In select cases an Atrial Fibrillation Ablation may be warranted.
I hope you've learned a great deal about what you can do to prevent episodes of atrial fibrillation.
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today on Medicine with Dr. Moran. I'm Dr. Keith Moran. Get healthy and stay healthy.