.

>> Good evening and thank you so much for watching us here on PBS Fort Wayne and I think you'll be glad that you are because we have a topic tonight that probably is going to be familiar to you either you personally or someone in your family, someone you know we're going to be talking about a medical issue tonight, specifically atrial fibrillation.

We have a cardiologist, a specialist in that field with us here in the studio tonight that we'll be taking your phone calls.

>> You can see the phone number here on the bottom of the screen and you can give us a call here in the next half hour and the doctor will answer your questions shall I say the doctor is in.

>> I guess that's going to be the topic this evening.

>> Please meet Dr. Scott Mattson.

Welcome.

Well, thank you and thank you for having me here.

Well, this show if you're familiar with that Dr. Manson is called like the head and what we do is try to give our viewers and our audience information and education that will help them in some life choies in their LIFE Ahead.

>> That's the name of the show here and we were talking just a few minutes ago in the break room before the show started and Dr. Madsen said this is going to be the perfect topic for our viewers and particularly in an age range of 55 and over and over because atrial fibrillation is more common as you get older.

>> That's correct.

So in people that are under the age of 50 you would see less than two and a thousand people who have atrial fibrillation when you're between 60 and 70 it's about five and 100 when you're are over 80, about 15 and 100 will have a relation and there are certain characteristic says to why that will be and we'll talk about that as we go on.

But it also gives them greater complications as a consequence of atrial fibrillation.

>> Oh well I'm interested in this next half hour for sure.

A lot of interesting things to talk about.

I want to tell you a little bit about the doctor.

I just want to verify to you his knowledge and expertize in this area so that you feel confident as you give us calls here tonight the cardiac just obviously he's also been a medical director and this is interesting.

He has his MBA in business.

>> So good for you.

You know, that's always a good notch to have also he is has clinical concentration with advanced cardiac imaging specialty in cardiac CT and cardiac MRI.

>> Somebody's got to know what they look like and what they mean and in and I'm this I'm going to ask about this to nuclear and echocardiography.

>> Am I saying this correctly?

You are those are the yeah.

Those are the major way that we image Haaz noninvasively OK so let's start let's just start from scratch.

>> What is atrial fibrillation if people don't know and is this what commonly is called a fib when people talk.

Yes a fib is a good abbreviation for it's commonly referred to as that.

So atrial fibrillation is a condition it's the most common important cardiac arrhythmia.

There are people who have palpitations.

They often have what are called premature atrial or premature ventricular complexes.

Most often those are not important.

Atrial fibrillation is the most common important cardiac for a couple of different reasons.

One is it can cause the heart to deteriorate over time and lead to things like heart failure.

Number two is if you already have an existing heart condition it will make that condition worse.

>> Oh really?

Yeah.

Any heart condition?

>> Almost any heart condition then third and very importantly is this ability to cause stroke.

>> So those are some of the most important reasons that atrial fibrillation is very important.

>> Why do we get it?

Where to come from?

What causes it so atrial fibrillation if we could see a second picture yeah.

>> We have some slides that the doctor has said show us what a heart looks like it OK kind of looking at the chambers of the heart and also the conduction system on top are two chambers called the atria.

So there's a right atrium left atrium and on the next slide the ventricles are identified so the upper chambers are called Atria and that's where blood collects in between a heartbeat when the blood is pumped out it has passed through those white structures in between them which are the valves and into the lower chambers and pumps out on the on the atrial slide you see these yellow pathway's and that's how electricity is normally conducted through the upper chambers and then it conducts through those to the lower chambers and beats if we go to the next slide we'll see how this happens.

So in between a heartbeat there is really not a lot of electrical activity.

Then the upper chamber starts a heartbeat which we see on the next slide and that produces this first wave on an electrocardiogram and that reflects the upper chambers being smaller, beating the lower chambers in beat which we see on the next slide and that makes this large inscribes on an electrocardiogram and then the whole system resets which we see on the next slide and that's what a normal heartbeat looks like.

>> So when we look at that on an electrocardiogram next slide please we see this strip where the upper chamber is small wave goes the lower chamber.

The big wave goes in, the entire system resets that is that paper strip that that's in the normal electrocardiogram right.

And that's a normal heartbeat.

OK and that we will contrast compared to what's referred to as atrial fibrillation which we can see in slide ten.

>> So in slide ten what we see those two upper chambers now have these circular pathways and that's the upper chambers more or less electrically disorganize and so instead of following those yellow pathways there is this all chaos in the upper chambers and that results in the heart beating rather irregularly.

And so if we go to the next slide when we look at the electrocardiogram strip now the heart beats are no longer equally spaced.

They're all chaotically spaced in there and they no longer have the representation of the upper chamber beating at all.

>> So that's what you would look at the spacing here on the spacing and that's why if you feel a pulse of somebody with atrial fibrillation, it's irregular.

>> It doesn't have a normal evenly spaced cadence.

Can you feel yourself?

>> A lot of people will feel it themselves.

A lot of people won't.

OK, so sustained palpitations feeling the heart beating irregularly maybe an indication that atrial fibrillation is present.

>> What if it's just in your mind it's beating faster?

>> Feels like if they're regular but you think well maybe it's because I'm really stressed or I just did a lot of exercise.

>> Should I be concerned?

You should be concerned.

But the way to discern whether the that is atrial fibrillation or is something other than atrial fibrillation usually the normal rhythm just running fast is whether the cadence is equally spaced.

>> So if a heartbeat is is very evenly spaced even if it's fast, even if it's fast OK, it won't be atrial fibrillation.

>> Got it.

Even if it's slow but grossly irregularly cadenced then that may be atrial fibrillation.

>> It could be other things too.

>> How could a person kill themselves at home to know whether they should come and see you and have a concern?

>> Yeah.

So if you are experiencing a number of irregular heartbeat symptoms like that it should be checked out by a clinician not necessarily a cardiologist.

Primary care physician can usually help sort that out an electrocardiogram if it were recorded during that time can do that.

So there are new biologic bios ,wearable things like watches that can record an electrocardiogram that is one way you could do it at home.

>> There are devices where you can just simply hold it like a credit card and it will record the electrocardiogram to your phone.

>> I know I think I've seen a commercial about that indeed.

Yeah.

Your thumbs .

>> I truly does work.

It does work.

It truly works.

It's highly reproducible.

It's highly accurate but you have to have it with you at a time in which one of those spells are happening.

>> So sometimes we'll need to put a monitor on somebody, send them home and watch several days of heartbeats.

>> You're watching that from your office or the lab or wherever it records it onto a device that can be transmitted to a recording center or they can just be recorded on the device and then download it.

>> I see.

I see.

All right.

Now we are getting some phone calls coming in here and again I welcome you to call us at (969) 27 twenty if you're out the immediate area just put out one 866 in front of that phone number and it'll be toll free for you.

So we welcome any phone calls here tonight.

Now Philip has just called and Dr. Madsen he has this question for you.

>> He said What symptoms should I look for that would indicate my a fib is worsening?

>> OK, so maybe Philip has his felt something that makes it makes him think he has hey Pip how would he know it's worsening.

So there's two important components of that question in my mind.

First of all, has the diagnosis of atrial fibrillation ever been established for the person in which you are wondering whether atrial fibrillation is present or not?

It really will require require an electrocardiogram at some point to make the diagnosis for certain but for the person who has had the diagnosis established already.

Yes.

Then the question is is it worsening and so what do we mean by that?

So there is a couple of things to know about atrial fibrillation and the first thing to know is as a person first starts having problems with atrial fibrillation, it is often what we call paroxysmal which is to say oh that's a word I don't know which they send X paroxysmal which is another way of saying episodic.

So OK, it comes and goes so there'll be a period of time in which atrial fibrillation is present and then you've gone back into the normal rhythm.

OK as atrial fibrillation worsens one of the ways worsens is those paroxysmal or episodic phases become more common and then it transitions into what we call permanent or persistent and that is a consequence of the atria or the upper chambers as we saw in that slide actually remodeling in a way that makes the atrial fibrillation more commonly present.

So one way atrial fibrillation may be worsening is that it's just more common and then as it becomes more common it may very well transition to a permanent formulation.

But the other way that I look at is atrial fibrillation worsening is is it producing symptoms?

>> So there are people well there are people who have no symptoms related to the age of operation or at least they don't discern any symptoms.

But symptoms can come beyond just palpitations and that includes exercise, intolerance, shortness of breath, easy fatigue, ability and even symptoms of heart failure and that is a consequence of the atrial fibrillation putting additional strain on the heart and causing heart function deterioration.

>> And if you are experiencing any of those symptoms then you definitely do need to seek some medical assistance right?

>> Yes, most certainly because then we want to either control the rate or control the rhythm of the regulation.

>> So if somebody is coming to you with what they think might be atrial fibrillation, what do you do first?

>> What do you start the testing with?

So if they have symptoms of atrial fibrillation but we haven't made the diagnosis, we're really going to try to make the diagnosis right.

And so if it's fairly common so somebody reports I'm having this several times a week then I can put a monitor on usually or patch recorders now they're just a patch that's put on we can send you home for a couple of weeks wearing this monitor.

>> I'll see every single heartbeat you have during that time and if you indicate I'm having that symptom now and then I match it to what we record I can tell you whether that was true atrial fibrillation.

Yeah, right or not.

And then we've established a diagnosis.

There are times in which we actually have to put what we call and implantable loop recorder which is a small device about the size of a triple-A battery that's been flattened down and you just lie and it lies under the skin and it can record every heartbeat for up to about three years.

>> So that's for the person who has much less common and we really want to make the diagnosis for instance, somebody who's had a stroke and we didn't know why but we thought it might be atrial fibrillation.

>> We would look that way.

We have a couple more folks I knew he'd be a popular person here tonight.

Again, you can call us here at (969) 27 twenty and Darcy has done that and she says that can you explain f b t I don't know what that stands for .

>> What is that.

So SVT stands for Supre ventricular tachycardia so if we go back to we don't need we don't necessarily need to go back to the graphic but if you think about that there were those two upper chambers to lower chambers so supre above ventricles so svt suprabhatam matricular tachycardia tachycardia simply means high heart rate so atrial fibrillation with a high heart rate technically would be a super alert where you're saying high heart rate do you mean fast.

Yes that's OK.

So technically if you have a fast atrial fibrillation that is a super ventricular tachycardia by definition that's not what we really mean by that what we mean by that and different from that atrial fibrillation is that this is a much more organized rhythm.

So it has a loop that's more or less running around constantly and that loop is causing the So if you felt the pulse of that one it would not have that irregular chaos.

>> It would have a very regular fast heartbeat.

Is tachycardia a serious issue?

>> So tachycardia refers simply to a heart rate greater than one hundred beats per minute.

OK, but it can be serious.

>> Can that be episodic also is definitely episodic.

OK is most commonly is episodic and the and that's really a more common disorder of young people whereas atrial fibrillation is something that you acquire over time.

>> All right.

Another question Fred.

Hi Fred.

Thank you for watching us here on like the Head.

And what is your question, Fred, for our doctor this evening?

>> Fred, are you with us here tonight?

>> He has a medication question I believe.

Hello, Fred.

Yes.

Oh, areas OK. >> What's your question, Fred?

With the cost of the anti stroke medication, is there any serious problem with taking them every other day?

Yes, there certainly is.

So what Fred is referring to when he said anti stroke medications are anticoagulants and so early in the discussion I said one of the complications of atrial fibrillation is that you can develop a stroke and the way you develop a stroke is that there's this little side chamber of the upper chamber called the left atrial appendage and as it's quivering in atrial fibrillation, a clot can form in there.

So all of the blood thinners are designed to help prevent a clot from forming in that upper chamber so Fred can I take my medication less common than it was normally prescribed?

And the answer to that question is no, you do not want to do that because the blood thinness is not reliable under that circumstance and so you you're not able to avoid the production of that clot.

You might even make yourself more clot prone when you do a trategy like that because of the way the blood thinner has come and gone.

But certainly you do not get the full effect the medication that way if the cost of the medication is too high, you should go to your provider and explain your costs.

This is giving you trouble.

Oftentimes we're able to find ways to get the medication at a reduced cost but it is a real problem for us.

>> Yeah OK well I'm sure Fred appreciates appreciates that I am sure go ahead and read.

>> Yeah one quick question.

Insurance agent has advised that it's possible to order that medication from Canada.

>> Is there a problem with that?

Well probably not.

There's probably not a major problem with that.

Certainly Canadian pharmaceuticals are generally of similar quality as US pharmaceuticals.

I'm not I don't know that I can give you any better advice on on it than than saying generally they have good pharmaceutical grade products.

>> Sure.

OK, all right.

Interesting question.

Yeah I think it probably comes up for you a lot.

I know somebody once that was ordering medicatin and it wasn't for for April.

It was I think an antidepressant or something from Turkey and it was like I don't think that's a good OK, we're back to Catherine now.

Catherine has this question for you, Doctor.

>> She called in and she said Can you describe what a heart murmur is like in an told?

>> OK, so a heart murmur is a description of abnormal heart sounds.

So when a physician puts a stethoscope on yeah over the heart we hear a flow sound and that flow sound is what's described as a murmur.

>> So it's not necessarily a condition that's related to atrial fibrillation but many conditions that have atrial as a component would also have a heart murmur such as valves that leak or valves that don't open properly.

So what you are hearing what we are describing when we talk about a heart murmur is that we hear a flow sound during a heartbeat that is making a noise is usually not expected so indicative of some heart condition.

>> OK, how would you narrowpthas starting with some of the other testing so atrial ablation doesn't make abnormal sounds of murmurs per say but what you do want to when somebody has a heart murmur and or atrial fibrillation as you want to& know really what's going on with the heart.-So when you mene tests at the beginning of the introduction, you mentioned echocardiography.

Yeah, echocardiography is a very common Tasco Graham Echogram is another way people describe it.

It uses ultrasound to make a television picture of the heart and we can discern from that the cause of a murmur.

But not only that when somebody has atrial ablation you can actually look for clots by using echocardiography.

That's the source of stroke or you can see other abnormalities of the heart which also tell you what you need to be dealing with when you treat atrial fibrillation.

>> OK, I also was curious about the terminology nuclear.

>> So what's that?

Yeah, so that is a little bit different concept altogether and not again related to the age of religion per say that's a test that we use to look for evidence of blood flow abnormalities mostly blockages in heart arteries.

>> So nuclear is simply a way that we use a radioactive tracer to image a heart.

It's a very common stress test .

>> Is that a case where you determine whether you need to put in stents or or do some sort of care that's on the on the pathway to determining things like stents or bypasses hopefully saying that you don't have a problem with that?

>> Exactly.

OK, Fran, thank you so much for calling us here, Fran.

>> And she says that she was diagnosed with A P, B, C and her previous doctor who moved wanted to OK, a question is just coming in I'm sorry for the slow part here but we're getting that typed up and and it's going to be on the prompter here.

So her previous doctor who moved to do an ablation we'll have to get a description of what an ablation is that doctor moved away.

>> How should she follow up on that?

>> So ablation is a eval is an evolving technique that a cardiologist known as an electrophysiologist performs OK and so an electrophysiologist is a hard electrician and what they can do is they can take a specialized catheter up into the heart and find where a heart rhythm abnormality is.

So in atrial fibrillation we can find the sources of these abnormal rhythms and that electrophysiologist can produce a scar that will localize it and contain it and that way they can get rid of the atrial fibrillation.

>> She ask about PVCs.

Yeah, contemplations er those are in the ventricle.

What does that mean premature ventricular complex premature ventricular complex and too many of those if you have an awful lot of PVCs that can lead to cardiomyopathy or heart muscle disorder and heart failure.

So Paepcke ablation is a specialized form of ablation where we are going after a source in the lower chambers not like atrial fibrillation but the ventricles to control an abnormal heart beat source that SVT that was talked about earlier.

And one another question those are often treated by ablation because we can find that big loop put it put a stopper in it and that's cured.

>> So ablation is a highly effective potentially curative strategy to treat arrhythmias including atrial fibrillation or PVCs or sweetie's.

>> It sounds very complicated.

I know it does.

Right?

Well, I mean our heart is a pretty complicated thing against running our home.

>> It's an amazing thing.

OK, here's a question from and she says that is a blood thinner the most important medication for your heart and should everyone be on a blood thinner?

>> What do you say to that?

Well, the second question is very easy answer didn't know it's emphatically no aspirin given to the entire population is going to cause more bleeding complications then heart protection because it wasn't that kind of a trend for a while like you know, everybody took an aspirin a day, right?

>> It was and then that by studying those type of population treatments it's easy to determine that we're going to cause more harm by doing that and then benefit to the whole population.

>> So what you want to do is find the selective individual in which a blood thinner helps them out.

So atrial fibrillation blood thinner is a very important medication because of the ability to prevent stroke.

Nobody wants to stroke and stroke risk increases that person as a person ages.

We also use blood thinners for things like stents mentioned earlier which is blockages in the arteries and not related to arrhythmia necessarily at all.

So a blood thinner is not necessarily the most important medication for the heart but it is a very important medication for many people with heart conditions and in we return to atrial fibrillatin it's a very important discussion.

So anyone who comes in with atrial fibrillation we're going to sit down.

We're going to talk about what the benefits and what the risks of blood thinners are because blood thinners can give you big trouble.

If you told me, for instance, that you had had a recent bleeding ulcer, a blood thinner may not be such a good idea if you told me that you had had a bleeding in the brain, we had to accept be careful about giving that person a blood thinner because I could cause them to bleed in the brain and no one is going to come back and pat me on the back for that one.

>> Probably not.

Yeah, right.

So yeah, that's an interesting conversation.

So when I'm hearing then is if I don't take advice from your neighbor or or your grandmother or whatever, you talk to your doctor and find out about aspirin or any other blood thinner.

>> We only have 30 seconds left in our show.

It has gone so fast and it's going to have a couple of sentences to share with our viewers that would be a recommendation.

>> Atrial fibrillation is a very important diagnosis.

It is very common as people age.

It is very common in the person who has high blood pressure whereas other valvular issues and so those people need to be very alert for those conditions.

The blood thinner that was talked about before is exceptionally important.

You need to interact with your physicians to understand the pros and cons of these things and and take it from there.

But it's a manageable condition and so stay on top of it.

>> They're all right.

I'm glad you gave that last sentence.

I was getting a little frightened there for a while but you said it is manageable again.

Now we want to give our thanks to Dr. Scott Mansome for all the information he shared.

>> Thank you so much for being on LIFE Ahead.

And again, if you want to tell some of your friends or family this show is going to be airing again four more times here through the weekend so you can tell them or you can watch it online on our PBS website.

Thank you for watching and we'll see you next Wednesday night at seven thirty