Starting with the punchline : we should listen to our own bodies and eat when we’re hungry. Don’t starve yourself but also don’t eat the moment you wake up, whether you are hungry or not. Don’t constantly graze either. If we were meant to graze, we would be cows. I want to present both sides…
pill in pocket anticoagulation
2 pilot studies have been published looking at the following question: can patients take anticoagulation only when they are in AFIB and not during other times? What makes this feasible is the availability of the DOACs (direct anticoagulants) which start acting in 2 hours unlike the older drug warfarin that would take 3-5 days to…
pain & AFIB
There have been several anecdotal examples of atrial fibrillation associated with chronic pain. The REGARDS study followed 30,239 patients over 4 years. The prevalence of AF was higher in opioid users than nonusers (12.5% vs 7.6%). The postulated mechanism is : Endogenous opioid peptides open mitochondrial potassium ATP channels, making mitochondria resistant to oxidative stress….
sleep apnea & AFIB
Half the patients with AFIB also have sleep apnea. Patients with sleep apnea have 4 times the risk of developing atrial fibrillation. How does sleep apnea contribute to AFIB? Potential mechanisms: Changes in intrathoracic pressure during apneic episodes leads to left atrial stretch. Intermittent periods of hypoxemia (low oxygen) and hypercapnia (high carbon dioxide) related…
leaking roof, rotting timber
ARREST AFIB trial Dr. Dennis Lau from Adelaide, Australia made this analogy at the Heart Rhythm Society meeting in San Francisco. He works with Dr. Prasanthan Sanders’ group. This group published one of the seminal studies regarding lifestyle and AFIB – the ARREST AFIB trial. Lifestyle factors that lead to AFIB are like the leaking…
anger, hostility and AFIB
Elaine Eaker et. al. published an interesting study in Circulation in 2004. It followed 1769 men and 1913 women from the Framingham Offspring Study. It showed that after adjusting for known risk factors such as age and high blood pressure, researchers found several traits significantly increased the risk of atrial fibrillation in men. Those with…
don’t be an Eeyore
Having type D personality is not good your cardiovascular health. Type D personality has 2 traits: Negative affectivity (worry, irritability, gloom). Social inhibition (reticence, lack of self assurance). The prevalence of Type D personality is 21% in the general population and 53% in cardiac patients. Cause or effect? Type D personality affects health related quality of life in…
anxiety, depression & AFIB
Bidirectional relationship There is a complex relationship between depression, anxiety, and AFIB. AFIB can cause depression and anxiety in patients. Depression and anxiety may create an environment that is conducive for the initiation and perpetuation of AFIB. Depression and anxiety affect how patients perceive their illness, and impact healthcare utilization. The presence of depression and…
AFIB & dementia
AFIB may cause cognitive decline via multiple mechanisms: Stroke Multiinfarct dementia due to microinfarcts Microbleeds as a result of anticoagulants Cerebral hypoperfusion – decreased blood flow to the brain Decline in brain volume Beta blockers ??may contribute Catheter ablation for AFIB contributes to micro infarcts (ACE – asymptomatic cerebral emboli) AFIB may be a marker…
AFIB shrinks your brain
Steffansdottir published a study on brain volume in the journal Stroke in 2013. In it she states: AF is associated with smaller brain volume and the association is stronger with increasing burden of the arrhythmia. These findings suggest that AF has a cumulative negative effect on the brain independent of cerebral infarcts. The difference in…