 In tonight's Your Health segment, Dr. Siobhan Chaturvedi, Professor of Neurology at the University of Maryland School of Medicine, Director of the Stroke Program for the University of Maryland Medical System. Doctor, thanks for being with us. Thank you. We want to focus on AFib, which is atrial fibrillation, big words. What does that mean? Atrial fibrillation refers to an abnormal heartbeat. And so in the normal heart, there's an upper chamber called the atrium and a lower chamber called the ventricle. And there's supposed to be a coordinated signal from the upper chamber to the lower chamber. And in atrial fibrillation, instead of being coordinated, it's very chaotic. And so for you can imagine that if there was an on-ramp to a highway, one car should get on at a time. But imagine what would happen if 10 cars tried to get on at one time. Things would be pretty chaotic. And so that's somewhat of an analogy to atrial fibrillation that the beating of the upper chamber is not well coordinated and a lot of different signals are trying to get through. I understand millions of people will have this and some of them don't know they have it. That's correct. Currently in the United States, there are about three million people who have AFib. And some, but there are other patients who don't know that they have it. And one important thing is that you may have heard that there are 10,000 baby boomers turning 65 every day. And so AFib is strongly linked with the aging of the population. And so there are projections that the number of patients with AFib is gonna double in the coming decades. The people who have it don't know they have it. Are they ignoring something or are there no symptoms? Sometimes there can be symptoms. And for example, the normal heart rate is 60 to 100. But with AFib, sometimes the heart rate can become quite rapid. It could become 150, maybe even 175. And so if it starts to become rapid, patients may develop a fluttering in their chest. They may feel short of breath. They may have palpitations. They may feel excessively fatigued. And so those are some of the potential symptoms. But then there are other patients who don't really have any symptoms. And yet they go in and out of AFib. So they may have it for five minutes or half an hour. And then their heart goes back to a normal rhythm. And so those cases are some of the ones where it's less well detected. And it's important to know because the irregular heartbeat comes along with a risk of stroke. Correct. What's the connection? Yeah, so when the upper chamber of the heart is not beating properly and if it's not coordinating with the lower chamber, then if the blood just sits there, you can imagine like a stagnant pool of water. And so when the blood just sits there, it's more likely to form a clot. And then if those clots get dislodged, they can travel up to the brain and block the blood flow to the brain and that can lead to a potentially very serious stroke. And I've read it tends to be among the most serious kinds of strokes. Yes, the blood clots from atrial fibrillation, they tend to lodge in like some of the bigger blood vessels leading up to the brain. And so because of that, the corresponding strokes that they can cause tend to be larger on the whole and that can be associated with higher rates of disability and even death following a stroke. So what should people be aware of here? So there are several things. Number one, if you've been diagnosed with atrial fibrillation, you need to know what are some of the potential hazards. And so the potential hazards are sort of in two categories. One relates to the heart because if the heartbeat is going too fast, as I said, it can cause shortness of breath, it can lead to heart failure. And then the other major hazard is the risk of stroke. And so it's very important that patients who know that they have AFib, that they be put on blood thinners, especially if they're higher risk for stroke. And so they need to discuss with their physician or their cardiologist whether it's appropriate for them to be on blood thinners because blood thinners are extremely effective at reducing the risk of stroke. And yet they're still very underutilized across the country. There have been studies that only about 40 to 50% of the people with AFib who should be on blood thinners are actually getting them in the real world. Why would they not be getting them? Because they haven't seen a provider or there's an issue with there being a risk of being on the blood thinner. There's several potential reasons. One is that they may not see a physician regularly. But another one is that sometimes the communication between the physician and the patient is not optimal. And sometimes the physician may think that aspirin is sufficient for AFib because aspirin is a fairly weak blood thinner. But the studies clearly show that aspirin is not really that effective for preventing stroke with AFib. And that's why you need to be on stronger blood thinners such as warfarin, or there are some newer medications these days such as Dabigatran, Epixaban, Riveroxaban. Those are some of the medications. And the people that unfortunately wind up in your care at the various hospitals having suffered a stroke, you see people who could have been helped by one of those drugs. Yes, that's something which is very heartbreaking to all neurologists probably across the country when we see somebody come in with a large stroke with atrial fibrillation when we think that it could have easily been prevented if they had been on proper blood thinning medication. Let's take a phone call. Carol County, this is Jim. Jim, thank you for the call. Go ahead. Jim, are you there? Yes, I'm here. What's your question? Thank you. I'm 79 years old, I've been treated for AFib for six years roughly. I'm taking Maltac, Renexa, and Elkwis for controlling the occasional AFib. I'm considering RFiblation. How effective is that? And does the AFib usually come back? Jim, great question. Best of luck, sir. Thank you for the phone call. Yes, so what the caller was referring to is something called cardiac ablation. And so some cardiologists who specialize in abnormal heart rhythms, they can do a procedure where they try to zap the tissue, which is causing the abnormal firing. And zap is not a technical term, but that's the goal of the ablation, is to try to eradicate the area which is firing abnormally, and then hopefully you can prevent the AFib from reoccurring. And it's fairly successful. It can help in terms of relieving symptoms, such as shortness of breath. And, but in some patients, it can come back after the ablation procedure. So in general, about five years after the ablation, maybe 30% of the AFib has come back. Mike, on the line from Cecil County. Mike, thank you for calling. What's your question? How is there a relationship between AFib and exercise? Interesting. Cardiovascular on the treadmill, et cetera. Mike, thank you very much. Yeah, now that's an interesting question because there's more and more research about how lifestyle changes can reduce your risk of AFib. And AFib can be linked with a number of conditions including obesity, sleep apnea, hypertension. And so if somebody exercises regularly, and especially if they're able to lose some weight, that could be helpful in decreasing the number of episodes of AFib they have and what's referred to as the overall AFib burden. What about coffee? We once talked about some link between people who have these gigantic cups of high strength coffee and an AFib episode. Yeah, regular consumption of coffee like the average person if they have like say two to four cups a day, that's probably not a major contributor. But on the other hand, as you said, if somebody has like a large slug of energy drink with a lot of stimulants, that can definitely trigger abnormal heartbeats and also a rapid heartbeat. Let's get to a quick call from Prince George's County. This is Okan, thank you for the call, go ahead. Yes. Your question? Question is what kind of blood pressure medicine should we avoid because some of the blood pressure prescription medicine causes AFib. Interesting, thank you very much. Is that the case? Some blood pressure medications can actually be useful for controlling the heart rate. And so for example, there's a category called beta blockers which slow down the heart rate. And so those actually could be beneficial for some patients with AFib as long as they don't have other reasons that they can't take beta blockers. Let's end with the most important thing which is getting people who are having a stroke rapidly into a medical center that can take care of them. Quickly the symptoms that people should look out for. Yeah, so the major symptoms they should watch out for are a weakness of one side of the body, speech problems, sudden onset of unexplained dizziness, facial droop. And so if you have any of those symptoms, especially if you're in the first within six hours, it's best to go to the emergency room right away. But these days there have been breakthroughs so that even some patients can be treated within 24 hours of the stroke. Very good. Dr. Chaturvedi, University of Maryland School of Medicine. So thank you very much. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.