Health

Atrial Fibrillation: What you need to know

By: Dr. Elizabeth Cosmal-Cintron, Florida Heart Associates

By: Dr. Elizabeth Cosmal-Cintron, Florida Heart Associates

Atrial fibrillation (also known as Afib) is a common cardiac arrhythmia defined as an irregular heartbeat with heart rates that can often become very rapid.  Data from the Centers for Disease Control and Prevention indicate that over three million people in the United States have atrial fibrillation.

The heart is made up of four chambers: two atria and two ventricles.  Electrical conduction normally moves from the atria (top portion of the heart) down through the ventricles (bottom portion of the heart) which causes a regular heartbeat that allows the top and bottom chambers of the heart to work together.  This permits normal flow of blood through the heart which is later pumped out to the rest of the body.  In the setting of atrial fibrillation, the heart beat becomes irregular causing the atria to quiver and the top and bottom heart chambers to become out of sync.  Blood is not pumped out in a regular fashion and can often pool in the atria increasing the risk of blood clot formation.  This blood clot formation can lead to an increased risk of stroke.  In addition, uncontrolled heart rates, which may occur with atrial fibrillation, can often lead to increased hospitalizations and increased morbidity/mortality. 

Individuals who have underlying atrial fibrillation may often experience symptoms of palpitations, chest discomfort, shortness of breath, and even lightheadedness.  It is not uncommon, however, for someone to be entirely asymptomatic.  That is one of the reasons why regular check-up’s with your physician can often be essential in the diagnosis of atrial fibrillation.

There are several risk factors for atrial fibrillation including advancing age, uncontrolled or untreated thyroid disorder, underlying coronary artery disease, valvular heart disease, excessive use of alcohol and diabetes just to name a few.  Individuals who have atrial fibrillation have four to five times higher risk of stroke compared to those who do not have atrial fibrillation. 

Data from the Centers for Disease Control and Prevention indicate that over three million people in the United States have atrial fibrillation.

Data from the Centers for Disease Control and Prevention indicate that over three million people in the United States have atrial fibrillation.

When diagnosed with atrial fibrillation, physicians often utilize a scoring system (CHADS2 or CHADS2-Vasc) to determine a patient’s risk of stroke based on the number and type of underlying risk factors.  If a patient has a score of greater than or equal to two, they will often be considered for blood thinners or one of the new oral anticoagulant drugs.  Obviously, blood thinners may also have a risk of bleeding and a patient would need to be evaluated for their risk of bleeding prior to initiating any one of these drugs.

The management of atrial fibrillation often involves follow-up with a cardiologist who will evaluate a patient’s baseline cardiac status prior to initiating medical therapy.  Along with various lab work, a 12-lead electrocardiogram is often used to determine a person’s heart rhythm and heart rate.  In addition, an echocardiogram (heart ultrasound) can determine if a patient has heart failure or valve disease as an etiology for their atrial fibrillation.  A monitor may also be ordered to assess the frequency and duration of atrial fibrillation which may help guide medical therapy, such as adjustment of medications.  Finally, a stress test may be utilized to evaluate for inducible arrhythmias, as well as the likelihood of underlying coronary artery disease, which is also a risk factor for the occurrence of atrial fibrillation.

However, a cardiologist may consider other forms of treatment such as cardioversion.  This is where a patient is appropriately sedated and electric shocks are then sent through electrodes that are placed on the chest wall of the patient.  The electric shock can be used to restore a patient’s abnormal heart rhythm to normal.  This procedure is often used along with medical therapy in patients for which atrial fibrillation is believed to be persistent (lasting longer than seven days and not converting back to normal rhythm on its own).

Finally, minimally-invasive catheter-based procedures can be used when medications and/or cardioversion fail to treat a patient’s atrial fibrillation.  The two major techniques are radiofrequency (RF) ablation and Cryoablation.  RF ablation uses heat to form scar tissue around the pulmonary veins, which are believed to be a source for the abnormal electrical currents which may initiate atrial fibrillation.  Cyroablation is a procedure where cold temperatures are used to remove heat from the tissue surrounding the pulmonary veins.  These procedures can be used to improve a patient’s quality of life and potentially eliminate atrial fibrillation.  A patient is first referred to a specialist that will determine which patients are considered appropriate candidates for these catheter-based procedures. 

Atrial fibrillation is a common cardiac condition found in millions of Americans.  Identification of a person’s risk for developing this disease is essential, along with close follow-up and cardiology referrals.  Many advances in medical therapy are now available for the management of atrial fibrillation.  In addition, appropriately-selected patients now have easier access to catheter-based procedures used in the treatment and even elimination of atrial fibrillation. 

– Dr. Elizabeth Cosmai-Cintron is a board certified cardiovascular disease specialist with Florida Heart Associates.  She is interested in educating people on preventive heart care and maintaining good heart health through proper nutrition, exercise and reducing risk factors that leads to heart disease.  For more information or to schedule an appointment, please call her office at (239) 938-2000 or visit her website at www.flaheart.com.

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Fighting Eating Disorders

Asking questions about eating behavior and weight concerns is critical to making the diagnosis.

Asking questions about eating behavior and weight concerns is critical to making the diagnosis.

Anorexia nervosa, bulimia and binge eating disorder affect up to 5% of young women, are associated with high use of medical resources, but often go unrecognized.  Men with eating disorders are even more likely to elude detection.

One should be alert to signs and symptoms of these relatively common behavioral disorders. Most cases respond to specialist treatment, although rates of medical morbidity, functional impairment and mortality are high, especially for anorexia nervosa, which has the highest mortality of any psychiatric condition.  Patients may deny they have an eating disorder; and some degree of symptom concealment is common, as these conditions are associated with high levels of ambivalence towards treatment, as well as feelings of shame, embarrassment and stigma.

Patients frequently present to a variety of medical specialists including pediatricians, internists, gastroenterologists, endocrinologists, gynecologists, neurologists, cardiologists, orthopedic specialists and psychiatrists seeking help for medical or psychiatric complications of their eating behavior, whether or not they acknowledge their diagnosis. They may avoid treatments focused on normalizing their eating behavior, favoring instead medical interventions that address consequences of their behavior without altering the underlying problem.

Tips to Diagnosing an Eating Disorder

Asking questions about eating behavior and weight concerns is critical to making the diagnosis when an eating disorder is in the differential, the history should include direct questions that assess dieting behavior, binge eating, self-induced vomiting or regular laxative, diuretic or diet pill use in the service of weight control.  Affirmative answers should be followed by clarifying questions regarding frequency and severity of each behavior.  Collateral history from family regarding changes in exercise, dieting, bingeing or purging behaviors and weight or shape concern can be very helpful in confirming the diagnosis. 

Several screening instruments exist.  The “SCOFF” is a rapid four question screening tool with good sensitivity and specificity that is easily included in a routine medical history.  

“S”: Do you make yourself SICK (vomit) because you feel uncomfortably full?

“C”: Do you worry that you have lost CONTROL over how much you eat?

“O”: Have you recently lost more than ONE stone (14 pounds) in a 3-month period?

“F”: Do you believe yourself to be FAT when others say you are thin?

“F”: Would you say that FOOD dominates your life? 

Additional probes for anorexia nervosa include questions regarding desired weight— “What would you like to weigh?” and dietary habits — “Tell me what you eat at each meal on a typical day”.  A desired maximum weight below a BMI of 19 in an adult is suggestive of anorexia nervosa.  In anorexia nervosa and in bulimia the dietary repertoire is characterized by skipped meals and limited food choices, typical food choices are of low calorie density and fat content.  In patients who binge, binges are usually secretive and involve intake of large quantities of high calorie density foods associated with a sense of loss of control over eating.  

Complications from eating disorders are best thought of as consequences of starvation or of bingeing and purging behaviors.  Eating disorders can affect all organ systems and are therefore at highest risk for severe complications.

– February 21 – 27 is National Eating Disorder Screening Week.  A simple screening can help raise awareness about a national epidemic, aid in early intervention and save lives.  For more information visit, www.nedawareness.org.