I recently educated a middle-aged male patient with diabetes during diabetes management sessions who was suffering from a cardiac issue of which he had no understanding. This poor patient was “in the dark” about what was happening to his heart and he felt too intimidated to ask the real important questions. His diabetes had been diagnosed after the heart condition although his physician indicated that he probably had diabetes for years and it caused his “atrial fibrillation” condition since the diabetes was never recognized and was uncontrolled. Since cardiovascular disease is a major risk factor of diabetes, I thought this was a good time to review his specific condition, atrial fib, to clarify some much needed information.
My Doctor Said I Have Atrial Fibrillation and I Could Have a Big Stroke. What Does That Mean?
Atrial fibrillation is a type of arrhythmia or irregular heartbeat. Over 2.7 million Americans suffer from atrial fibrillation. Usually the 4 chambers in the heart: the atria (upper chambers) and the ventricles (lower chambers) beat in an organized and timed fashion. The heart contracts and relaxes in a controlled manner. With atrial fibrillation, the atria beat chaotically or in a quivering manner which could cause shortness of breathe, heart palpitations, funny sensations in the chest, nausea, light headedness and generalized weakness. People who have diabetes for an extended time, especially when uncontrolled, are at an increased risk of atrial fib. People with diabetes are at a 40% increased risk of this specific arrthymia. According to The American Heart Association “untreated atrial fib doubles the risk of heart related deaths”. It can lead to heart failure and cardiomyopathy, the most serious heart conditions. One of the major complications of atrial fib is the formation of blood clots. When blood clots form in the heart, it causes a myocardial infarction or heart attack. Blood clots to the brain cause a stroke. Both of these conditions are higher in those with diabetes. Blood clots can occur in the lungs called pulmonary embolism or in a limb called an embolism. Blood clot formation can obstruct blood flow leading to ischemia or death of the tissue. Some people who have atrial fib experience no symptoms but many become symptomatic.
What are the Possible Causes of Atrial Fib?
In addition to diabetes, other possible causes can be hyperthyroidism, obesity, hypertension, recent cardiac surgery, sleep apnea and drinking excessive amounts of alcohol. Each of these situations may trigger atrial fib. If the arrthymia continues, the physician will choose the best treatment for you. Generally a cardiologist is the specialized physician to consult with but there are cardiac electrophysiologists which offer even more specific treatment for cardiac arrhythmias.
How is it Diagnosed?
The diagnosis is made by a complete physical exam and history, a CBC (complete blood count), an electrocardiogram, an echocardiogram, possibly an exercise stress test and a ambulatory Holter monitor.
What is the Treatment?
There are several aspects to be addressed for the treatment of atrial fib. It usually includes slowing the heart rate to 110 beats per minute (since it is very rapid and irregular) which requires a medication called a beta blocker which slows the heart rate. Anticoagulants are used to reduce the risk of clotting blood. The original and most common anticoagulant used is Coumadin. The positive aspects of Coumadin are that it is cheap and has shown good results over the years. The negative aspects of Coumadin are that it increases the risk of a brain bleed, requires a monthly (or more frequent) blood test since medication levels are fluctuating and it requires you to lower or eliminate Vitamin K foods which includes many salads and green vegetables. The newer anticoagulants are Xarelto, Eliquis and Pradaxa. These are only recommended for those patients without heart valve disease. Your physician will make the recommendation based on your personal situation. These all work in the same manner by “preventing pooled blood in the heart from clotting”. These medications do not interact with Vitamin K or require frequent blood test monitoring. Unfortunately they are much more expensive so check with your health insurance for coverage.
This is a treatment often done at the hospital bedside which requires a supervised low level electrical shock from a defibrillator to “convert back to a normal rhythm”. This is performed by a cardiologist, nurse and an anesthesiologist. This can be a final treatment for some who return to normal sinus rhythm but unfortunately atrial fib returns in many patients.
Another available treatment is a cardiac ablation. An electrophysiologist does this procedure in a lab setting under light anesthesia. It is usually done through the groin and not considered open heart surgery. The heart is “mapped out” and the affected area can be burned or frozen to eliminate the irritable section of the heart. Often this procedure needs to be repeated but many patients have positive long term results.
Lifestyle cannot be neglected as a treatment for atrial fib. Keeping A1C levels to 7% or below is extremely critical. Blood pressure should be kept at 140/80 or less. Sleep apnea must be treated with a proper fitting CPAP mask after a full sleep study is done. Losing weight or being close to your ideal BMI is also recommended. Eating a plant based diet may be useful in lowering cardiac risks. Eliminate all alcohol if you suffer from atrial fib.
Left atrial appendage occlusion
The newest procedure done at a few select medical centers is called left atrial appendage occlusion or LAA. It is a more permanent solution and allows the patient to stop medication for atrial fib. The left atrial appendage is “a small ear shaped sac in the muscle wall of the left atrium”. Due to the erratic behavior of the atria and the heartbeat, blood can collect in the LAA and form clots. Research shows that atrial fib without heart valve involvement is mostly caused by the LAA. There are multiple procedures to seal off the LAA that should be evaluated by you and your primary physician. This procedure is not without risks.
Atrial fib is a serious complication common to those who have diabetes. Know what you are dealing with and do not be afraid to ask the right questions. Always remember that knowledge really is powerful!
Have a question or comment? Post below or email me at RKleinman@adwdiabetes.com if you would like to share them with ADW diabetes.
NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.