Okay. Welcome to those that are joining. We're letting a few more people join our health chat today. So give us one more minute and we'll get started.
Okay.
Okay.
We are going to go ahead.
Give me one sec.
Alright, sorry about that. I just needed to do a little technical thing there.
All right. There we go. We have quite a good turnout for today. So it is my pleasure.
My name is Shanna. I'm with Adventist HealthCare. I'm going to be your moderator for this important health chat on women in atrial fibrillation or AFib. We've had an excellent response to the topic for today and we are really excited to provide meaningful information to our audience for today.
Just some housekeeping notes. Everyone is muted so we don't have any background noise. If you have any questions during the chat today you can drop them either in the Q and A or the chat and we'll get to them throughout today's chat.
I'll try to intersperse them as we had a great response and we had a lot of people actually ask questions.
So I'll either leave them to the end or I'll intersperse them throughout.
And it is my pleasure to introduce our wonderful experts for today. We have Doctor Tushina Jain, who is an electrophysiologist with Adventist HealthCare Cardiac Associates located in Rockville in Silver Spring. Welcome, Doctor Jain.
Thank you.
And then we also have Doctor Daisy Lazarous with us today. She's a general cardiologist and women's heart specialist, also with Adventist HealthCare Cardiac Associates, as well as the director of the Women's Cardiovascular Program here at Adventist HealthCare. So a very distinguished panel here today to talk to us about women and AFibs. So thank you, Doctor Jain and Doctor Lazarous for joining today.
Okay.
We will go ahead and get started. Our first question, just to kind of set us up, actually I'm going to stop sharing my screen so that everybody can see Doctor Jain.
First question for today's Health Chat is, Doctor Jain, tell us just what is atrial fibrillation? How does it what's caused how does it happen? What's caused how does it how does it start?
Yeah. So atrial fibrillation is a very common rhythm issue that we see. It's an issue with the electrical conduction system in the heart. And it's basically the top chambers of the heart, the atria, are beating in a very irregular, erratic fashion rather than the steady, regular, normal heartbeat. And that can lead to problems with the blood flow, the ability of the heart to pump blood effectively essentially.
Okay.
And then what does it feel like with AFib? How do you know that you might be having this condition?
So, first of all, a lot of people don't realize that they're having it actually. It can be very subtle. So some patients don't realize that they're in atrial fibrillation. But the symptoms when people do feel them are typically like feeling an irregular heartbeat, feeling their heart racing. But it can also be very variable, just feeling more fatigued, having lower energy, more short of breath with activity, lightheaded. So it really can have kind of a variety of symptoms.
Okay. And actually, should have started out. Doctor Jain, you are an electrophysiologist, which is a special kind of cardiologist. Can you actually talk a little bit about how you work in particular with this condition?
Yeah. So I specialize in the electrical rhythm issues in the heart. So I treat AFib. That's kind of one of my specialties. I do basically treating all the slow fast heart and irregular heart rate. So this is something that I commonly see and treat every day.
Okay. Thank you. Doctor Lazarous, as our women's heart specialist, how common is AFib among women compared to men? Is there anything that makes it a little different in women than men?
Yeah, that's a very good question, Shana. And I hope all of you had a very good Thanksgiving. So actually, the prevalence of atrial fibrillation is greater in men. About one and a half times higher in men. However, women live longer.
There's an aging population. So when we look at that, then we tend to see lots of AFib in women.
Okay.
Also, women tend to have more conditions that promote atrial fibrillation, such as high blood pressure.
As we talk we'll let you know how significant high blood pressure is toward having one go into atrial fibrillation. So women who have high blood pressure tend to have thicker heart muscles. We call it left ventricular. Left ventricle is the main public chamber.
Hypertrophy. So women tend to have that. Women tend to have valvular heart disease. It's valves are involved and that makes AFib very commonly occur and heart failure is one of the triggers.
So all of these make the incidence of atrial fibrillation high in women.
Okay, thank you.
Doctor Jain, are there any subtle signs? You'd actually talked a little bit about it being kind of subtle.
Can you talk a little bit about some of those subtle, more of those subtle signs that might be overlooked?
Yeah. So, yeah, again, fatigue, low energy are is can be very subtle. And then, you know, sometimes it can even just like feel like anxiety for some people And yeah, I think especially in women, those signs can be more subtle. I think men tend to kind of present more with the classic symptoms oftentimes where their heart is pounding very quickly and women may not have that sort of typical presentation.
Okay. I'm going to move a little closer to the microphone.
Hopefully you all can hear me all right, but if you're having trouble I'll speak up.
Thank you for that, Doctor Jain and Doctor Lazarous, are there some unique risk factors to women that would make atrial fibrillation more put women more at risk?
Oh yes, we talked about the degree of hypertension being more in women.
We talked about valvular heart disease, and we talked about a special kind of heart failure that's related to the high blood pressure. We call that diastolic heart failure. That's the old term, but now we call it heart failure.
Good preserved means good pump ejection fraction. So women tend to have the two kinds of heart failure. One, the ventricle is not pumping. It's very weak. Like the engine of your pump. It's very weak. It's not going forward.
The other kind is the ventricle pumps very strong, but it doesn't relax very much. That's the kind that women get. So that's strongly associated with atrial fibrillation. Also, there are certain stages in a woman's life that she gets more atrial fibrillation.
Menopause.
Once we reach menopause, it's estimated that one in four women will get atrial fibrillation sometime along that period of time. So because hormonal changes are occurring, we lose our oestrogen and oestrogen as you know is very protective and also the FSH other hormone levels go up. All of this is related to makes the atria as Doctor Jain said it's the two upper chambers that are involved more fibrotic. Fibrotic means they thicken, they scar and that causes more atrial fibrillation and makes it difficult for atrial fibrillation to be treated.
Okay.
Last sort of opening questions before we get into some of the more specific questions we received when folks registered. Doctor Jain and Doctor Lazarous, maybe we'll start with Doctor Jain and Doctor Lazarous, chime in if you have anything to add.
How is atrial fibrillation treated? What are different treatment approaches?
Yeah.
So there's different facets to the treatment. Number one is lifestyle modification, which is like the initial thing that we always talk about with our patients, kind of modifying some of the risk factors that they can change, which can be things like stress reduction, exercise, weight loss, if they're overweight, sleep hygiene, treating conditions that Doctor Lazarous mentioned, like high blood pressure, heart failure, and the other cardiac conditions.
In terms of the specific management that we then offer for atrial fibrillation, one aspect is to try to control the heart rate.
When patients go into atrial fibrillation, the heart rate can be very fast. So we want to try to control the heart rate so that it's not super fast, which can cause more symptoms. And then another aspect is actually trying to maintain them in a normal rhythm, which we call a rhythm control strategy.
And the options for that are medications to try to keep them in normal rhythm or ablation procedures, I perform, which is a more invasive procedure. But it is not open heart surgery. It's a catheter based procedure that's performed to treat AFib. And then the last aspect is preventing stroke.
Because the blood is not pumping as efficiently in the atrium, that top chamber of the heart, the blood can kind of stagnate there and form blood clots more easily and which can then travel to the brain. Stroke prevention is a key aspect of it, which usually involves the blood thinner.
Okay. Shana, let me add something to Yes. Doctor Jain has been through the whole series of what you do with atrial fibrillation. As he said in the beginning, I'm a noninvasive cardiologist. My philosophy is prevention.
We believe prevention is cure.
Doctor Jain said it so eloquently.
We want to modify your risk factors. So that's something all of you in the audience can do easily. What is that? Control your blood pressures. When I say control, it means keep your blood pressures below one hundred thirty over eighty at all times.
And then body weight is actually very much linked to atrial fibrillation. So if you can reduce even a few pounds or work toward that, that would be good. And a lot of times patients do not realize that they are at risk for sleep apnea.
And you have to make sure that you get a sleep study.
Your cardiologist will tell you or your primary care, but I see a lot of resistance to people going to get a sleep study, but it's vital that you get a sleep study because Doctor Jain could do a nice ablation and they come out, they're not in AFib and then one month later they're back in AFib. Why? Because the sleep apnea was not treated. So it's extremely important that you modify the risk factors that you have control over.
Okay excellent. Are there any differences in treatment approaches for women in particular?
May have something to do with the modifiable risk factors.
What I've seen is doctor Jain may be able to talk to that further. It's just the different kinds of ablation techniques. You know, we talked about the atria being the culprits, the two upper chambers, and the pulmonary veins, these are all fancy terms, but they bring blood back to the heart. And the the area where doctor Jain is going to do your ablation is around the pulmonary veins.
But we have found that in women, those are not the frequent triggers. Just men that is successful. For women the triggers are elsewhere within the atria. So there are techniques like that that are different.
Certain aspects of age that are different in women than in men. Doctor Jain, can you talk more toward that or some other risk factors, techniques for women?
Yeah, I mean, think that's definitely true. When I perform ablations, know, I always try to keep it in a very individualized approach and I try to check what all the triggers might be for that particular patient. And certainly for women, there can be other locations in the heart that can be the triggers.
And then I think think in general, though, the the pillars are kind of the same for men and women.
And also stroke prevention, women are at generally higher risk for stroke. So that's just something to be aware of and why really early diagnosis is very important for for women.
Okay. And may I add a few things to that Shanna?
Yes, please.
Just like Doctor Jain said, you control your heart rate because AFib tends to be a very fast fast heart rhythm. You control it and then you go to a rhythm control then you try to get them out of the atrial fibrillation. What we found though is women tend to not tolerate many of the medications the same as men do. That's the that's the difference.
And oftentimes because of that we under dose.
We don't give them the adequate dose so that's there and we have found that drugs like Doctor Jain would use very commonly and I would use amiodarone.
All of you may have heard of it, but it causes more slow heart rate in women than in men. Bradycardia is more common and one of the other things we use a drug called Digoxin very commonly you have heard of Digoxin and we found now that women tend to have higher mortality or death rates on Digoxin and also we found out recently that it tends to cause more invasive breast cancer. So we have to be very like Doctor Jain said individualized in how we treat women as compared to a man but the general pillars are the same as what Doctor Jain said.
Thank you. I've heard you say it before Doctor Jain and it always makes me laugh. Women are not small men.
Exactly.
Yeah Thank you.
We've had a couple of questions actually come into the chat that I think are really good questions. So I'm going to start actually there.
What are the best or standard tests to diagnose atrial fibrillation?
So, yeah, generally, you know, if we have a patient that is concerned that they might have atrial fibrillation, we start off with a rhythm monitor, which is basically a patch that is placed on the patient's chest.
So it monitors the rhythm usually for about two weeks, just continuously monitors the rhythm so we can see if they're having any atrial fibrillation.
And, you know, now nowadays there are other options that, you know, a lot of patients use, like Apple watches, wearable monitors that can also kind of be a constant detection tool for underlying atrial fibrillation. But, yeah, in the office, we generally start with the with those patches.
K.
And I want to add to that because we used to be able to only do a certain amount of monitoring in a woman, anybody. And now we can do anywhere from one day to thirty days, and now doctor Jain can put in a little thing in here that's called a implantable loop recorder that can record up to three years. So we are suspecting that you're having little mini strokes, and we can't catch it, but we think it's because of AFib and Doctor Jain would do that procedure called an implantable loop recorder and that can monitor you for three years. Yeah and like Doctor Jain said we're using a lot of smart watches And there's one device that I really like that's very portable.
That's called the Cardia Mobile. And I don't know how much doctor Jain is, but I tell all my patients about it. I do not have stock in the company. Just kidding.
But it's it's like a credit card, and you will take it wherever you go and you just have to put your thumbs on it and it will record an EKG strip. It's very accurate so it's only about seventy or eighty dollars so I tell my patients if they're anxious that they're having episodes of atrial fibrillation to get that because it links to your phone and it transmits and your doctor can see it too. So that's another method of doing it.
Nice it's amazing what technology allows us to do and take such an active role in our monitoring of things. So thank you for that.
One other another question from the Q and A came in. Is atrial fibrillation reversible? Maybe Doctor Jain or and then Doctor Lazarous if you have anything to add.
Yeah, definitely, again, with lifestyle modification, you can modify it. It's not, you know, a person probably has that electrical predisposition in their heart towards AFib if they've developed it.
But certain things can cause that left atrium, that top chamber to dilate, to stretch out, which predisposes to AFib, including like sedentary lifestyle, overweight, high blood pressure, heart failure, all the things we've talked about. So, if we can reverse those modifiable risk factors, then we can certainly decrease the burden.
I think it's, in most patients it doesn't completely cure it but it can at least decrease the burden with those things.
Okay. Thank you.
And then one other question that came in. We got a lot of questions that came in not only when people registered but as they come in. I want to keep an eye on our time. Is an enlarged heart a factor for AFib?
Yes.
You know, you have high blood pressure, when you have heart failure, the chambers tend to dilate just like Doctor.
James and especially the upper chambers, that's where the A fib is, dilates or enlarges, you get atrial fibrillation tendency. And then as more they dilate, it becomes very hard to get them out of the atrial fibrillation with medication or Doctor Jain's techniques like the ablation. Yes, the heart dilates.
Okay. Question for both of you. Why does it seem like we're talking more about atrial fibrillation these days?
Is it just Yeah, I can Why are we talking about it more?
Yeah, we're talking about it more because we're diagnosing it more of it. Like I said, we are living longer and we have have become so good at diagnosing atrial fibrillation different means of diagnosis we're talking and we now know how important it is especially in women. The stroke risk just like Doctor James said. So we have to do everything in our power to make sure that they do not get a stroke, which is a most devastating complication of of stroke of atrial fibrillation.
Yeah, I agree with that. I think one of the aspects of definitely the increased diagnosis. I also think that our perspective on treatment of AFib has really evolved.
Back in the day, you know, it was more so thought that controlling the heart rate in atrial fibrillation is sufficient.
But nowadays we have a much more specific approach for a lot of patients, especially if it's newly diagnosed, to really try to maintain them in normal rhythm. Because we have a lot of studies that have shown that the longer that you're in atrial fibrillation, the longer that you let it progress, it can really lead to a lot of, it can lead to heart failure actually over time. It can lead to decline in the heart function.
It can lead to more symptoms later on, even if there's not a lot of symptoms when it's initially diagnosed. So I think our management of it has really become, in a way, a little more proactive, a little more aggressive when we initially diagnose it.
Thank you.
Next question, actually, we'll stay with Doctor Jain.
After experiencing an episode of Afib and you have that fatigue and you're tired, how can you manage the fatigue that may come from that?
So basic things like trying to stay well hydrated, resting, trying to focus on stress reduction, getting adequate sleep. Those are kind of the things that I would say when you have had an acute episode and you're recovering from it.
Okay. Is there a difference? Doctor Jain, we'll stay with you. Is there a difference between AFib and irregular heartbeats?
Yeah, so irregular heartbeat is a symptom that someone might feel. But AFib is a specific diagnosis. So, yeah, irregular heartbeats can be a symptom of AFib, but it can also just be due to other things, not due to AFib. It could just be due to benign extra heartbeats that you might be having sometimes or it could be a different rhythm issue.
Okay. Thank you.
Doctor Lazarous, we'll jump over to you at this point.
I've been treated for another if you have another heartbeat condition and are managing it with medication, could A fib be a risk for you?
It could be because the other rhythms, many of them also lead to structural, what we say, the the atria remodeling or becoming structurally different. So, yes, it could the same mechanism could could lead you to have into atrial fibrillation. One thing I want to focus is to make sure that patients when they are given medications to lower your heart rate, make sure that they don't skip it because then your heart rate goes up and you get very fatigued and very anxious and all and to make sure that you treat the reversible causes. One thing that's often missed is thyroid disorders.
Okay, if you can have hyper or hypothyroidism that can lead to atrial fibrillation. So when you have these symptoms just make sure you talk to your doctor to make sure there are no other reversible conditions that and of course the sleep apnea.
Thank you.
Skipping back to Doctor Jain, you know, you talked a little bit about, the ablation type procedures. Are there other type of procedures available for AFib that might be available out there?
So in terms of procedures, there's so basically it's ablation to treat atrial fibrillation. Now, some people might have heard of a cardioversion, which is a simpler thing. It's a noninvasive procedure where basically if you're in atrial fibrillation and it's not, it's what we call persistent, where it's persisting, it's not going in and out of atrial fibrillation, you're just constantly in atrial fibrillation.
We put two pads on your chest essentially, give you sedation, electrical energy through the pads to shock the patient back into normal rhythm. But this is really for most people, just a temporary fix. You usually need either some, you need some medication in addition to that in order to maintain normal rhythm. The ablation is a more curative procedure and the goal is to not have AFib after that.
Okay. And it sounds like the next question I think you've talked just a little bit about, but obviously the individualized approach that you take, obviously an ablation may not be right for everyone. Is it generally safe and effective for older patients Or, you know, how do you go about maybe looking at someone from, you know, with their individual unique needs?
Yeah. So I think it is, especially patients in their 80s. I think it's a very effective method for treating AFib. And it really depends on the individual patient, what their other medical conditions are, how active they are, If they're, you know, very in good shape otherwise and pretty healthy, I often recommend ablation because ablation, again, the studies over the years have really shown that it's more effective than a lot of the rhythm control medicines and less side effects compared to the medications. And especially in older patients, they tend to be more prone to those side effects like the slow heart rate, the fatigue from the medications.
So if they're otherwise healthy, then I think ablation is definitely a reasonable option. And I don't see it as like a strict age cutoff.
Okay.
A question came into the chat that I think is a really good one. Are there different, can women, experience different success rates with ablation versus men or just is it generally well tolerated by everyone?
Yeah, I don't think that gender wise, there's really much of a difference in terms of the ablation, success or how they tolerate it. Yeah. Okay.
Is it common for people to have maybe need more than one procedure in their lifetime?
It's not common. Most people are treated with one ablation and it's usually very effective. Maybe like one in ten might require a second procedure, and very, very rarely another one after that.
Okay. I think that answers a couple. Any risks for the ablation, you know, common things?
Yeah, I mean, is a procedure. It's, you know, something is going inside of the body, but overall, it's less than one percent chance for any major complications like stroke during the procedure, heart attack during the procedure, need for open heart surgery, like extremely unlikely.
And then the anesthesia related complications, if there are any, the patients are under general anesthesia for the procedure. But again, it's pretty well tolerated now.
Okay, thank you. I'm just going through the questions here to make sure we're getting all of them. Then I still have some more that came in from the registration. So just bear with me. I want to make sure we get everything and that we don't miss anything but also that we don't kind of rehash anything.
Okay.
There we go. Okay. Got everything there.
Are there any new treatments or research developments focused around AFib in women in particular or just in general? Doctor Jain, maybe you know anything that's up and coming.
Yeah. So it's constantly evolving field. The technologies for actually doing the ablations are constantly improving. So traditionally, over the years, the two kind of main methods for doing an ablation, which essentially during the ablation, what it is, is we're scarring a little bit of the tissue in the heart where atrial fibrillation comes from, where that abnormal electrical tissue is.
So, the two methods traditionally were either heat energy, radiofrequency energy, or what we call cryoablation, which is freezing the tissue there.
But now, in the last couple of years, there's a newer technology called pulsed field ablation, which is essentially delivering electrical field energy to kill those heart cells. And it's shown to be safer compared to the other methods because with the other methods, there's a higher risk of injury to nearby structures like the esophagus or one of the nerves that stimulates the diaphragm. But this pulsed field ablation is more specifically works on the heart cells to really target the tissue that we're trying to go after.
And it also has been quicker because of the way the technology is.
So there's, yeah, there's constantly things in development. This is one of the more exciting new things in the field right now.
Okay, thank you.
Let's see here.
Doctor Lazarous and then Doctor Jain, if you have something to add.
What are the most important questions or what do you encourage women on our talk today to ask their doctor if they're worried about their risk for AFib or have AFib? How can they advocate?
I always tell my patients that you come prepared.
That means you write down your questions. It's very, very important because I if I don't do that, I forget when I go to my doctor. So, oh, I forgot to ask her that. Him or her.
So write down your questions and make sure that sometimes it may be you can bring somebody who who you trust to come with you so they can hear what they what's being said, and, you know, there's no miscommunication. I also tell patients that what is my risk of stroke because that is the number one risk factor and strokes can be very devastating in women. So ask the doctor what is my risk of stroke and what can I do to prevent a stroke? And remember that even if you have one stroke a year, one AFib episode a year, just one, you are set up for a stroke.
So it's very very important that you you ask the doctor what are my chances? How can you let me know what way how many episodes I'm having? Like doctor Jain said, they can monitor you and also ask about specific medications that are suitable for you.
Again going in with some degree of what you want to ask the doctor is very very important.
Okay thank you for that. Some other questions that have come into the Q and A.
Doctor Jain, this one I think you should be able is for you.
If the medication are no longer working or not well tolerated and ablation didn't work, are there other options?
Yes, it depends on the kind of specific clinical details. If the issues are that the patient is having a very fast heart rate while they're in atrial fibrillation, for example.
Usually, again, this is after at least three ablations probably I would try on a patient if they needed. And if none of that has worked, then sometimes we actually do a different kind of ablation where we're helping to control the heart rate specifically. And then in that situation, we also need to put in a pacemaker.
And so sometimes that can be kind of a last line resort to help.
And then sometimes, you know, surgical ablation is also performed in very rare cases, which is, you know, more invasive. It's in that's performed by cardiac surgeons, which is like an open heart surgery. If they really need to actually treat the atrial fibrillation and get out of that abnormal rhythm for some reason.
Okay. I'm going to do a quick adjustment and see if I can I got a comment that my microphone is a little low? So, I'm going to try to just get a little bit closer to it if I can't I can't get it.
So just give me one second.
There we go. Maybe Okay, that should help.
There we go. I apologize. Hopefully that helps a little bit. Doctor Sorry, I lost my place, as I was fixing my microphone.
Doctor Jain, is, you talked about some of the newer advancements in there like the pulse, ablation. Is that something available here at Adventist HealthCare?
Yeah, it is. Excellent.
That is such a great, I mean, you know, we have wonderful heart care services, at Adventist HealthCare and I'm comforted to know that we have some of the newest and these great experts that are up on all the latest and greatest. So thank you.
Let me check our Q and A there.
And I hear I see people saying much better. So I apologize if it was low earlier.
Let's see.
We had a couple questions come in about diet and exercise. So I'm gonna hold those just so we get more of the atrial fibrillation thing in. I'm just gonna hold those until the end.
Oh, here we go. Doctor Jain, can mild atrial fibrillation go untreated, or minimal intervention like a blood thinner?
Yeah, if the patient is not having symptoms and it's truly like they're having very infrequent episodes, then that's totally reasonable to just monitor what we call the AFib burden to see if they start having more episodes if the AFib is progressing.
Okay, thank you.
So now let's transition a little bit to lifestyle. And I know in the beginning we talked about that a little bit and we talked about some of the risk factors. But Doctor Jain and Doctor Lazarous, can you just reiterate here at the end? What are some lifestyle changes that we can do that women can do to help manage Afib and and their overall heart health? And then how much do things like stress and sleep and physical activity influence your heart rhythm?
Yes.
So there are like you said at the beginning of the seminar webinar. There are risk factors that we can modify ourselves.
One of it is a very important risk factor is how you manage your high blood pressure.
So you have to make sure that your blood pressure is controlled at all times. Otherwise remember the heart muscle thickens, the atria where the AFib comes from dilates. Somebody asked that question the heart enlarges. So and we I want to just make a quick point.
We say that the blood pressure has to be below one hundred thirty over eighty at all times.
We know about the risk of stroke, we know about heart failure, all of those things, atrial fibrillation.
But what we didn't know till last year was that even if it's one or two points above one hundred thirty, and I want my the audience to listen to this very carefully, it it can cause early dementia.
So, blood pressure normally if I see one hundred thirty three over eighty I'll say okay, you're okay. Nowadays I don't say your blood pressure has to be below one hundred thirty over eighty because it's a very big risk factor for dementia. So, high blood pressure, weight is a very big one. So if you can do even losing five or ten pounds, no you don't have to go lose thirty five-forty five pounds. Just starting toward the journey toward managing the weight.
And like I emphasized before you have to be investigated for sleep apnea. Very very very important.
You know just having high blood pressure is now an indication to do a sleep study even if you're not overweight. Just remember that. Yes stress is a big factor. Lack of sleep is a big factor. So if you can avail of some techniques that can that can help you and that includes just relaxing if you have five or ten minutes a day doing some mindfulness exercises and yoga is a very good thing actually It relaxes you, Tai Chi is a good thing, so anything that can relax you and like Doctor Jain said earlier sleep patterns are very very important.
So make sure that those kind of risk factors and one risk factor that people always forget oftentimes is alcohol.
So alcohol is very very strongly related to atrial fibrillation. Now you can even have you saw the data last year the year before that came out that said that no amount of alcohol is safe for you and we now we really think that no amount of alcohol. But even drinking one drink can trigger AFib in people who are susceptible like Doctor Jain said people who have their underlying triggers and especially binge drinking. So, I know a lot of us like to go out and Fridays or Saturdays and drink three or four drinks but that is a big trigger for atrial fibrillation. So, if you can keep that in mind that alcohol is a big trigger that would be very good.
Okay all right a couple other questions have come in the Q and A. So if you do have any last little bit of questions please drop them in. We are almost through all of our user submitted questions from registration. So, we're doing really excellent on time.
I know we have two cardiologists on today, but a question came in about primary care physicians. You know, they're such an important part of our care teams.
Do, how do primary care, do they also, are they also able to do tests for atrial fibrillation? How closely do they work with with you all for that as well?
So they do work very very closely with us. So I always tell patients that some of my patients they like to see only the specialist. They feel that a specialist offers something more. I tell them that's not the case.
It is a primary care who sees the patient as a whole who gathers information from all their consultants and puts it together. So they can detect atrial fibrillation very quickly. They can examine you and see that your pulse is irregular. They can do an EKG and they can order the monitors and then say depending on what they want go see Doctor.
Doctor Lazarous or Doctor Jain if they think that's appropriate. They can pick up the underlying conditions like thyroid disorders, heart failure, all of that primary care is able to do. So always start your journey with the primary care physician.
Okay excellent thank you.
A point of clarification. In the beginning, I think it was you Doctor Lazarous that mentioned some of the commonly used drugs or medications for Afib besides digoxin.
Could you just clarify what some of the other ones were it was missed we use a lot of antiarrhythmic doctor Jain told you that nowadays the strategies to try to get you out of the fibrillation into a normal rhythm We found that that improves your quality of life, your life expectancy, and improves your risk of stroke.
But many of those drugs can in itself cause arrhythmias. We call that a proarrhythmic effect so and that's sensibly more common in women. So you've heard of drugs like flakonide, you've heard of drugs amiodarone, sotolol, of ibutilide. All of those drugs can have very many toxic effects but experts like Doctor Jain and even I treat a lot of atrial fibrillation we know how to regulate that at the moment.
Okay Another question.
Doctor Jain, please chime in. Do women with irregular heart rates and blood pressure or high blood pressure from pots? I'm not sure what that is but maybe you all can clarify that one. Have an increased risk for AFib?
Yeah, so POTS stands for postural orthostatic tachycardia syndrome. So it's a very specific diagnosis, but yeah, in general, know, these other conditions like POTS, for example, can increase the risk of AFib. Anything that really increases the heart rate at baseline or increases your blood pressure.
Okay. Emphasizing even more, Having the conversation with your physician, your cardiologist about risk factors for, you know, heart anything heart related.
Mm Okay.
Doctor Lazarous, you've talked a little bit about modifying risk factors, you know, controlling your blood pressure, your risk for stroke, sleep, all of that. What about caffeine? How does that play into risk factors?
You have mercy about caffeine. So I still tell patients because dehydration is one of the big triggers being dehydrated and caffeine dehydrates you. So I tell them to avoid dehydrating liquids like sodas and caffeine and alcohol But the data about coffee drinking is mixed. A large scale study just came out that actually coffee is beneficial in reducing the episodes of atrial fibrillation. So from the standpoint of not getting dehydrated, I tell my patients to lower their coffee intake, but generally Doctor Jain can speak to it. We are not quite sure what coffee does to your risk of atrial fibrillation.
Yeah, I agree. I think I usually say like avoid excessive caffeine. Like, I mean, one cup a day, I think is certainly fine.
Yeah, one to two cups is probably okay.
Okay, thank you.
And in our final little moments here, we did have one question come in a little earlier. And again, we've emphasized a lot about these modifiable risk factors controlling your sleep and your blood pressure and physical activity. Doctor Lazarous or Doctor Jain, do you do you ever offer any suggestions diet wise that can be done to just kind of get a a small thing that can help those that are looking at controlling their weight.
I always tell patients it's not so much what you eat, it's the amount that you eat. So, you can limit portions.
I never say don't eat this don't eat that. If you can limit portions and keep an eye on that that is really comes a long way in helping you.
So if for an average sized woman I don't like exceeding fourteen to fifteen hundred calories a day but different people say different things but if you can limit the portion size it's very good and remember that you have to cut down on salt because salt leads to hypertension and salt will make your heart failure worse. So salt exceeding fifteen hundred milligrams or one point five grams of sodium is bad for you for all the different reasons for your heart and people have asked me what one point five grams sodium is and it's two thirds of a teaspoon for the whole day and all the size of my nail. So it's very very little salt and keep in mind that even every processed food has a lot of salt. So my guidelines are cut your portions and watch your salt, keep hydrated and exercise.
Okay Doctor Jain any tips from you on small things people can do?
I agree with the calorie control. I think that's the main thing and then increasing fiber intake, vegetables, fruits, those things are the kind of simple things you can do.
Okay, thank you.
Another question that came in through the Q and A here that I wanna make sure we get to in our final minutes here.
If a pacemaker, and this is for Doctor Jain, if a pacemaker is needed, must it include a defibrillator for someone with infrequent AFib?
Yeah, so a defibrillator is kind of different indications for that. A defibrillator basically is a pacemaker that also has the ability to shock someone in case they have a dangerous rhythm issue, which is not atrial fibrillation.
It's something called ventricular tachycardia, which can be life threatening. And so that's really indicated for patients who have a heart failure with a weak heart pumping function.
So yeah, it's not generally indicated just for atrial fibrillation.
Okay, thank you.
Switching to another topic really quickly, Doctor Lazarous, you've mentioned the importance of sleep and sleep apnea being a risk factor. Someone just has a general question is, how do you even, how do you get a sleep study? How do you go about asking for that?
The best place to start is your primary care. Yes. They will refer you. They will give you the name in the doctor, the name of the practice. Perfect. So that is a very good way of doing it.
Okay.
And there are home sleep studies and the sleep study you do in the lab.
But they they are connected to all of these things.
Okay. Well, we are nearing the end of our time together. Before we I know Doctor Lazarous, Doctor Jain, you have some some quick key takeaways here to go over. One last question.
And since our topic today was all about women and atrial fibrillation, but in general, what advice do you have or what tips do you have for women in particular to advocate for their heart health when they're having conversations with their doctor?
I always say that the patient is their best health advocate. So if you don't speak up for yourself, nobody else is going to. So, you have to be somewhat not rude, not overpowering, but somewhat assertive and when you come to a patient doctor's office and let them know exactly what it is that you're concerned about.
That is and write down the questions I told you about that or bring someone that you can hear what the doctor is saying along with you and Doctor Jain can add to that.
Yeah, no I agree.
I think really focusing on when you're at the doctor visit to explain what it is that you're experiencing and make sure that that's like clearly communicated and that you get that feedback from your doctor that they're understanding.
Okay. Thank you. Alright, I am going to go back to share my screen and we're going to end on some last little points. We tried to get all the questions today.
If there was anything that was a little more particular to your unique case, obviously, you know, Doctor Doctor Lazarous has said it a few times. Doctor Jain, you know, please reach out to your your care team. To to help you and I'm going to share my screen one more time and we're going to tab through here. Here's our lovely physicians.
Okay our last little bit of time here Doctor Lazarous if you have I think a couple of these are your tips to end us on. If you could elaborate on these last little bits for people to take home with them.
So like I said in the beginning there are certain risk factors that you can modify yourself and the biggie is again repeating it is a high blood pressure, your weight, and sleep apnea. So if you can work on those risk factors that would be very very beneficial and always the key question for your cardiologist is what is my risk of stroke? Yeah, because especially if you have a bleeding risk like you're you're a bleeder, you bleed from your stomach or your colon and you can't take the blood thinners. What do you do? And so ask your doctor about the risk of stroke and Doctor Jain will tell you that in people who have a risk of bleeding we have other techniques that Doctor Jain does almost every day like watchman's device. We'll come to it that another day, but there are other things that you can do. But asking about the stroke risk and remember I told you at the beginning that even one episode of A fib a year can put you at risk for stroke.
So, and remember with the holidays coming, the alcohol risk that even one drink can trigger AFib in the appropriate patient and binge drinking particularly. So, if you could focus on the modifiable risk factors that would be great.
Thank you and stress too right it's the holidays. I know I'm feeling stressed with the holidays right here.
Doctor Jain any closing takeaways or one or two things that you want everybody to remember?
Yeah, I think kind of focusing back on the diagnosis of AFib, you know, I think it's really important to be aware of these subtle factors, subtle symptoms that can be a marker that you might be having AFib and really trying bringing that up with your healthcare provider, whether it's your primary care doctor first, to make sure that you get diagnosed early so that we don't miss it. Because again, the earlier that we treat atrial fibrillation, the better it is, the easier it is to treat before it progresses. So, I think really focusing on getting that early diagnosis and meeting with a cardiologist if necessary after that.
Thank you. Just like with a lot of things, early detection, advocating, paying attention to what's happening.
So, thank you. This was a wonderful health chat today. I'm going to I want to thank everyone for joining us today. We had a great turnout. Our excellent physicians experts for today, Doctor Lazarous and Doctor Jain, thank you for being here, giving up your time and all of this wonderful information.
If those on our Health Chat today want to learn a little bit more about Doctor Lazarous and Doctor Jain you can visit our website at veneshealthcare.com/doctors. We'll also do a follow-up to today's Health Chat email to those with links so you can learn more about Doctor Lazarous and Doctor Jain.
And don't forget we do these health chats pretty regularly. We also have other free classes and events that you can check out at AdventistHealthcare.com/calendar. So check out all community events and virtual events that we have.
And we'll send a follow-up email with the links for tomorrow. And again, thank you to Doctor Jain and Doctor Lazarous for answering our questions and to all of those that joined and took time out of their day to learn more about atrial fibrillation in women.
Thank you. Thank you, Doctor Jain. Thank you, Doctor Lazarous.
Thank you so much. Thank you.
Thank you.
