Clot Chronicles: Atrial Fibrillation as a Systemic Vascular Illness

Dr. Sam Goldhaber discusses the changing ideas around atrial fibrillation (AFib) in this episode of the Clot Chronicles.

Hello, I am Dr. Sam Goldhaber. I am president of NATF, and today on Clot Chronicles, we’re going to discuss atrial fibrillation (AFib) as a systemic vascular illness, as well as a heart rhythm problem. We’ve tended to think of AFib as a heart rhythm problem that can be easily diagnosed by physical examination and electrocardiogram as an irregularly irregular heart beat, where the atrium has stop contracting normally. This results in about a 20 percent reduction in cardiac output. Patients will often feel more fatigued than usual and some patients will have palpitations, or feel that their heart is jumping around inside their chest.

What we’re now learning is that AFib really extends beyond heart rhythm problems but can also result in an increased risk of heart attack, heart failure, stroke, and cardiovascular death. So, we realize now that in addition to anticoagulants, which we can use effectively to prevent most strokes from AFib, we have to be very aware that AFib is a marker for worsening heart failure and the possibility of heart attack. We have to double down our efforts to make sure that we do our best to prevent the development or the worsening of heart failure, and that we make sure that we are modifying risk factors for heart attack, such as cigarette smoking, high blood pressure, or diabetes, in order to minimize the risk of developing a heart attack in the presence of AFib.

We further know that with proper risk factor modification, we can help prevent some of the manifestations of AFib, with a reduction in cardiovascular death, heart attack, heart failure, and stroke. This now becomes a problem that we deal with not only with a cardiologist, but with a primary care physician and all of the health providers, such as nurse practitioners and physicians assistants. We need to increase their awareness of the potential ramifications of AFib.

This is Dr. Sam Goldhaber, signing off for the Clot Chronicles.