Living with AFib

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About the Rose Rocky Mountain Heart Rhythm Institute Our nationally recognized, highly experienced team treat arrhythmia (irregular heartbeats) by providing individualized, leading-edge care from first screening and diagnosis to treatment and support.

An arrhythmia is an abnormality in the heartbeat pattern, also called the heart rhythm. The heart may beat too slow (bradycardia), beat too fast (tachycardia), skip or add heartbeats or the heart beat may come from abnormal areas of the heart.

The Rose Rocky Mountain Heart Rhythm Institute offers the most leading edge diagnosis and treatment for atrial fibrillation, the most common arrhythmia.

Dr. Stees was the chief electrophysiology fellow at the University of Colorado in 2009. He was awarded the Gilbert M. Blount Fellowship in 2008 which recognizes outstanding clinical achievement and research potential.  He has authored or coauthored 17 cardiology and cardiac electrophysiology peer reviewed journal articles.

Dr. Stees’ interests include catheter ablation of complex arrhythmias including atrial fibrillation, atrial tachycardias, supraventricular tachycardias, and ventricular tachycardia. He also has an interest in sudden cardiac death prevention and risk factor stratification.

Since 1986, Dr. Svinarich has been practicing both interventional cardiology and cardiac electrophysiology at Colorado Heart & Vascular. After graduating from Carnegie Mellon University in Pittsburgh, PA, he attended medical school at Ohio State University and trained in medicine, cardiology and electrophysiology at Fitzsimmons Army Medical Center in Denver and Letterman Army Medical Center in San Francisco.

Dr. Svinarich is board certified in Internal Medicine, Cardiology and Cardiac Electrophysiology. He has performed well over 200 cryoballoon procedures. He has performed radiofrequency ablation procedures since 1991 and has extensive experience in device implantation and follow-up, including pacemakers and ICDs. He has a particular interest in bi-ventricular pacing.

Meet Your Rose Medical CenterHeart & Vascular Center Team

Bridget Beck, MD

John Altman, MD

Christopher Stees, DO

Julie Jaakola, RN

Richard Parker, MD

Takeshi Kataoka, MD

Sameer Mehta, MD

Norman Gray, MD

Lawrence Lazar, MD

J. T. Svinarich, MD

Jason Sperling, MD

Vijay Subbarao, MD

Michael Ptasnik, MD

Kristen Thanavaro, MD

Michael Wahl, MD

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Michael Cooper, MD Colleen Hupp, DO

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Danielle Elliott, NP Holly Kurtz, NP Barb Sullivan, NP

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AFib is short for Atrial Fibrillation (Ay-tree-yul Fib-ruh-lay-shin). AFib is when your heart flutters, or beats unevenly. AFib is the most common heart rhythm problem, affecting more than five million Americans. The heartbeat is controlled by electrical impulses that begin in the atria, or upper chamber of your heart. With AFib, these electrical impulses are erratic, causing a rapid and irregular heart beat that affects the heart’s ability to pump blood efficiently to the rest of the body. It is possible to have AFib without having any symptoms, or you may have a wide range of symptoms including:

• heart palpitations• fatigue or lack of energy • dizziness• chest discomfort or pain • shortness of breath• passing out or fainting

AFib can also lead to heart failure and is a leading cause of stroke. There is no single cause of AFib, but it tends to occur more frequently in people over 60 years old and in patients with heart disease. However, it can happen to anyone at anytime.

AFib can lead to a stroke. The irregular heart beat can make a blood clot form in the heart. The clot can break off into the blood stream and move to the brain. This cuts off the blood supply to the brain and causes a stroke.

AFib can lead to heart failure. AFib sometimes makes the heart weak. This is called heart failure. If you already have heart failure, AFib may make it worse. However, treating your AFib may make your heart failure better.

OVERVIEW

WHAT IS ATRIAL FIBRILLATION (AFIB)?

OVERVIEW

There are several types of AFib. The main ones are:

PAROXYSMAL • This type of AFib starts and stops suddenly. You may have symptoms for

only seconds or minutes, or the symptoms may last hours or days at a time.

PERSISTENT • This type of AFib comes back and doesn’t stop on its own.

• With persistent AFib, you need treatment to return the heart to a normal heartbeat.

LONG-STANDING PERSISTENT • This type of AFib is a continuous AFib that lasts more than 12 months.

PERMANENT • Permanent AFib continues even with treatment.

• The heart won’t return to a normal heartbeat.

• The goal of treatment is to control the heart rate to protect you from having a stroke or seek expert opinion on new treatment options of permanent AFib, such as ablation therapy or the Convergent Procedure.

DIFFERENT TYPES OF AFIB

OVERVIEW

Your doctor can tell you if you have AFib. He or she will take your health history and give you a physical exam. There are also tests for AFib. Questions your doctor might ask about your health include:

• What are your symptoms?

• Do you have a history of heart or lung disease, high blood pressure, or thyroid problems?

• What are your health habits (like smoking, drinking coffee or alcohol, and exercise)?

You will then have a complete check-up and other tests for AFib.

The picture below shows a normal heart and one in AFib. The irregular heartbeat caused by AFib can lead to stroke and can also produce uncomfortable palpitations and dizziness

HOW DO I KNOW IF I HAVE AFIB?

AFIB TESTING

EKG & ECHO (ultrasound) tests: • EKG (electrocardiogram EKG or ECG): the EKG records the electrical

pattern of your heart. It will show if your heartbeat is regular or irregular. • Echocardiogram: the ECHO technician gently presses a wand on your

chest. The wand takes pictures of your heart’s chambers and valves. The echo also measures how strong your heart pumps

Blood tests, such as thyroid and complete blood count, can also help to determine why you have AFib.

Sleep study to screen for Obstructive Sleep Apnea (OSA) • Sleep Apnea is a disorder characterized by abnormal pauses in breathing.

Each pause or “Apnea” can last just a few seconds to minutes, and can occur 5 to >30 times per hour

• Obstructive Sleep Apnea (OSA) is the most common form of apnea (84% of cases), and occurs when the soft tissue in the airway obstructs breathing. OSA can lead to physiologic changes that increase the workload of the right side of the heart; which can result in structural changes of the atrium, causing remodeling and AFib

Holter or event monitor: this is an EKG recorder you wear on your body for a certain period of time. It records your heartbeat. Your nurse or doctor will ask you to write down any symptoms you have while wearing it.

Stress tests: you may require a treadmill stress test to evaluate the rate - controlling drug effect in AFib.

Transesophageal Echocardiogram (TEE): this is another type of ultrasound that can be done with camera probe you swallow and the tech guides, with physician’s assistance, to look for any clots in the heart. It is typically done before a cardioversion.

INITIAL TESTS FOR AFIB

ADDITIONAL TESTS YOUR PHYSICIAN MAY ORDER FOR AFIB

TREATMENTS

MEDICINESMedicines can help by: • Keeping your heart from beating slowly, irregularly, or too fast. • Changing your heart to a normal beat. • Preventing a blood clot and a stroke.

ELECTRICAL CARDIOVERSIONThis treatment can put your heart back into its normal beat. Your doctor will give you medicine to make you sleep for a few minutes. Then the doctor gives your heart an electric shock. The electric shock stops the AFib and starts regular heartbeats.

CATHETER ABLATION CRYOABLATION (CRYO) OR RADIOFREQUENCY (RF)The doctor does a test to find the heart cells that cause your AFib. The doctor then eliminates these cells that cause the AFib with a catheter.

CONVERGENT PROCEDUREThe Convergent Procedure is a dual approach in which an electrophysiologist ablates from inside the heart and a cardiac surgeon ablates on the outside of the heart. This combined approach could improve success rates for patients with persistent and longstanding persistent AFib who want a minimally invasive (closed chest) treatment option.

PACEMAKERA pacemaker is a small device that can tell when your heart is beating too slow or too fast. It helps keep the heartbeat regular. Pacemaker is typically a later option when you have had AFib for a long time and the natural pacemaker in the heart stops working as well as it should.

TREATMENTS FOR AFIB

MEDICATIONS

Your doctor may prescribe medications to help treat your AFib. Below are some tips to ensure that you are taking your medications correctly.

ANTICOAGULANTS: PREVENTING STROKE BY PREVENTING BLOOD CLOTS WITH MEDICATIONS

To prevent blood clot formation your doctor may prescribe you a blood- thinning medication (anticoagulant) such as:

• Warfarin (Coumadin). If you’re prescribed warfarin, carefully follow your doctor’s instructions on taking it. How well warfarin works will be affected by your diet. You should eat about the same amount of vitamin K (found in asparagus, broccoli, cabbage, brussel sprouts, spinach) daily, as changing how much vitamin K you eat can change the lab value that your doctor checks. There are many possible drug interactions. Talk to your doctor or pharmacist before starting any new drugs (including over-the-counter and herbal supplements). You will need to have regular blood tests to monitor warfarin’s effects. This blood test is called a International Normalized Ratio (INR). It is used to monitor how well warfarin is working. Your doctor will order INR tests to make sure that the drug is working properly without causing bleeding or bruising. The usual target INR range for patients with AFib is between 2.0 - 3.0. Work with your doctor to know what your specific INR target range is. Your doctor will adjust your INR based on your condition.

• Dabigatran (Pradaxa), Rivaroxaban (Xarelto), Apixaban (Eliquis); Edoxaban (Savaysa). Dabigatran, rivaroxaban, and apixaban are newer agents that do not require blood tests to make sure the drug is working well. Rivaroxaban is taken once a day while dabigatran and apixaban are taken twice a day. These newer agents are not affected by the type of food you eat and do not require INR checks.

Report any signs of bleeding or bruising to your doctor (listed below).

MEDICATIONS

MEDICATIONS

While on blood-thinning medications it is very important to be careful during contact sports or any other situations that may cause bleeding. in case of a fall or head trauma, seek medical help immediately.

CONTACT YOUR DOCTOR IF YOU HAVE ANY OF THE FOLLOWING: • Unusual bruising • Feeling sick, weak, faint or dizzy • Red, dark brown or black urine or stools • Bleeding gums • Bad headache or stomach ache that won’t go away

THINGS TO REMEMEBR WHILE TAKING ANTI CLOTTING MEDICATIONS: • Call your doctor right away if you have any unusual bleeding or bruising. • If you forget to take your daily anticoagulant dose, don’t take an extra one

to catch up! • Always tell your doctor, dentist and pharmacist that you take one of these

medications. This is especially important before you start taking a new medication or have any procedure that can cause bleeding.

• Consult your doctor or pharmacist before starting any new drugs (including over-the- counter and herbal products)

• Do not suddenly stop your anticoagulant medication

MEDICATIONS

MEDICATIONS

BETA-BLOCKERS • This medication blocks the effects of stress hormones on the heart. When

you take beta-blockers, the heartbeats more slowly and with less force. • Beta-blockers may provide symptom relief by keeping your heart from

beating at a dangerously fast rate. • Take this medication exactly as directed. DO NOT SKIP DOSES. • Monitor your blood pressure and heart rate, as this medication may cause

your blood pressure or heart rate to become low. • If you are diabetic, these medications may mask the symptoms of

hypoglycemia so make sure to monitor your blood sugars closely. • While on this medication be careful when standing up from a seated

or lying position because this medication can make you dizzy or light headed.

SOME EXAMPLES OF BETA BLOCKERS INCLUDE: • Atenolol (tenormin) • Bystolic (Nebevilol) • Carvedilol (Coreg) • Metoprolol (Lopressor) • Nadolol (Corgard) • Propranolol (inderal)

HEART RATE CONTROLLING MEDICATIONS

MEDICATIONS

CALCIUM CHANNEL BLOCKERS • Calcium channel blockers have multiple effects on the heart. • They are used to slow rapid heart rate in patients with AFib. • Calcium channel blockers may provide symptom relief by keeping your

heart from beating at a dangerously fast rate. • There are two classes of calcium channel blockers. One group works in

the heart and is used for AFib while the other works in other areas of the body and is used in primarily for blood pressure control.

SOME EXAMPLES OF CALCIUM CHANNEL BLOCKERS INCLUDE: • Diltiazem (Cardizem) • Verapamil (Calan)

SOME EXAMPLES OF CALCIUM CHANNEL BLCKERS THAT ARE USED FRO BLOOD PRESSURE ARE: • Amlodipine (norvasc) • Nifedipine (procardia) • Nicardipine (Cardene) • Nimodipine (nimotop) • Felodipine (plendil)

CALL YOUR DOCTOR IF YOU EXPERIENCE ANY OF THE FOLLOWING SIDE EFFECTS WHILE TAKING ANY OF THE ABOVE MEDICATIONS: • Hives • Skin rash • Loss of appetite • Stomach problems, such as

nausea, vomiting, or diarrhea • Loss of vision • Confusion • Heart palpitations (slow or

racing heart beat, feeling like you skipped a beat)

• Dizziness • Decrease in blood pressure or

heart rate (it is important to discuss what is considered a normal or abnormal change with your doctor.)

• Flushing • Swelling in your hands and feet • Lethargy • Headache • Fatigue • Shortness of breath

HEART RATE CONTROLLING MEDICATIONS

• Antiarrhythmic medication help return the heart back to its normal rhythm and they can help keep this normal rhythm once it has been achieved.

• Antiarrhythmic drugs can have serious side effects that need to be monitored closely. Discuss the possible side effects of your medications with your doctor so that you will know what to watch for.

• Make sure to take these drugs as directed and do not miss a dose. • If your doctor has told you to take your medication with or without meals

continue doing so as food can affect how well the drug works. • It is recommended to avoid grapefruit and grapefruit juice while taking

some of these medications. • There are many possible drug interactions with these agents. • Consult your doctor or pharmacist before starting any new drugs

(including over-the-counter and herbal drugs).

SOME EXAMPLES OF ANTIARRHYTHMICS INCLUDE: • Amiodarone (Cordarone, pacerone) • Dronedarone (multaq) • Propafenone (rythmol) • Sotalol (betapace) • Dofetilide (Tikosyn) • Flecainide (tambocor)

CALL YOUR DOCTOR IF YOU EXPERIENCE ANY OF THE FOLLOWING • Dizziness, lightheadedness, or fainting • Trouble breathing • Swelling of feet or legs • Chest pain • Vision changes • Involuntary movements

HEART RHYTHM CONTROL MEDICATIONS ANTIARRHYTHMICS

MEDICATIONS

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MEDICATIONS

CHECK YOUR DIET Diet has a dramatic effect on how you feel. It has been suggested that patients with AFib adopt a lower sodium and low fat diet. AFib isn’t always related to a specific heart condition, but a diet designed for individuals with heart disease can be helpful for people with AFib. It is important to focus on eating a variety or fresh fruits and vegetable and use lean cuts of meat. It is also suggested to strive to eat fish two to three times per week. If you have more questions regarding your diet, please speak to your health care provider for more details.

WATCH THE VITAMIN K INTAKE Many foods can also affect how successful certain AFib treatments can be going forward. One in particular is for individuals who are prescribed warfarin to reduce their risk for blood clots. These patients need to be very aware of their vitamin K intake. Vitamin K, a nutrient found in green leafy vegetables, broccoli, and fish, plays a role in the body’s production of clotting factors. The consumption of vitamin K-rich foods while taking warfarin can cause unsteady clotting levels. This affects your stroke risk. Please remember these foods are an important part of your diet and should not be totally avoided. Be sure to talk to your doctor about the significance of vitamin K intake for your treatment.

MINIMAL CAFFEINE Caffeine is a stimulant found in many foods and drinks including coffee, soda, and chocolate for example. For people with AFib, caffeine may pose a threat since stimulants can increase your heart rate. AFib is sensitive to changes in heart rate, so something that changes your natural rhythm could cause an AFib episode.

But this doesn’t mean you have to cut caffeine completely. May studies have found that only high doses of caffeine drinks are problematic. A cup of coffee is likely fine for most people, but talk with your healthcare provider about your risks.

AFIB TREATMENT- LIFESTYLE MODIFICATIONS

LIFESTYLE MODIFICATIONS

LIFESTYLE MODIFICATIONS

SMOKING CESSATION As mentioned, AFib can be exacerbated by several stimulants and one in particular is nicotine. If you have diagnosed with AFib, it is a very wise decision to stop smoking. Stimulants can increase your heart rate and make the symptoms associated with AFib more pronounced and affect your overall quality of life. Additionally, quitting is good for your overall health. Smoking is a risk factor for several chronic diseases, including coronary artery disease stroke and cancer. Many people trying to quit have success with over-the-counter smoking cessation patches and gums. If those aren’t successful, talk with your doctor about other medications or therapies. The sooner you can kick the habit, the better.

LIGHT ON THE ALCOHOL A glass of wine may help take the edge off a bad day, but it could cause serious problems for your heart if you have AFib. Studies show that alcohol can trigger an AFib episode. Heavy drinkers and people who binge drink are more also likely to experience an AFib episode. But it’s not just large amounts of alcohol that can put you at risk. A few studies have found that moderate drinking, or having one to 21 drinks in a week for men, one to 14 drinks in a week for women, could lead to an AFib episode.

EXERCISE Exercise is important for your overall health and your heart’s health too. Regular physical activity can prevent a number of conditions and diseases that complicate AFib, including obesity, diabetes, heart disease and hypertension. Exercise is also good for your mind. For some people, dealing with AFib can cause some anxiety and fear. Exercise can help naturally improve your mood and prevent emotional issues.

RELAXATION Relaxation and rest are key components for healing of any process. Stress and anxiety can also increase your heart rate, which again can exacerbate your AFib. The right balance of work and life will overall benefit your heart health and is an essential piece in your overall well-being. If you make time on your calendar for meetings and other work related items, ensure your schedule also includes time that allows you some rest.

AFIB TREATMENT- LIFESTYLE MODIFICATIONS

WHY SHOULD YOU EXERCISE? • Remaining active is one of the best things you can do to improve heart health. • Activity can help you to have more energy and feel better. You should not feel

extremely uncomfortable when you are exercising. • Exercise is an important step in preventing AFib and other cardiac disease

BE SAFE! • Please check with your physician on the right level of exercise program for you. • Start slowly. • Stop immediately if you feel chest pain, dizziness or severe shortness of breaths.

TYPES OF EXERCISE • Walking • Stationary bicycle • Exercise class • Gardening

EXERCSIE TIPS • Start slowly. Remember your body needs time to get used to the increase

in activity. • Exercise with a friend or family member. • Wear comfortable clothing and shoes that fit well. • Balance activity and rest. Steps for doing more:

• Start by doing an activity for 10 minutes a day, 3 times a week. • After 2 weeks, add 5 minutes each day, so that you are exercising

15 minutes a day, 3 times a week. • When you feel comfortable increase your time by 5 minutes each day. • Your goal is work up to 30 minutes of exercise a day, 3 times a week.

BE SURE TO CHECK WITH YOUR PHYSICIAN BEFORE MAKING ANY CHANGES TO YOUR EXERCISE PROGRAM

EXERCISE AND ACTIVITY

EXERCISE & ACTIVITY

EVERY DAY ACTIONS • Check your pulse daily. • Learn about your medicines. • Eat healthy foods like vegetables, fruit, whole grains, and healthy fats. • Stop smoking.

HOW DO I FEEL TODAY?You can tell how your heart is doing by how you are feeling and what you are able to do. • Am I experiencing any chest discomfort? • Am I short of breath when walking? • Am I short of breath while sleeping? • Am I feeling faint or dizzy?

IF YOU ANSWER YES TO ANY OF THESE QUESTIONS – YOU NEED TO CONTACT YOUR DOCTOR.

WHEN SHOULD I CALL MY DOCTOR?Call your doctor if: • You notice increased shortness of breath or if your daily pulse remains

increased above 100 per minute. • You experience lightheadedness, dizziness or the sensation that you are

about to pass out. • You have any tightness, heaviness or discomfort in your chest. • You have any unusual numbness, tingling, or weakness in your arms

or legs. • You have any difficulty with speaking, such as slurring your words. • You have any bleeding or unusually dark (black) stools.

DAILY CHECK IN

CHECK DAILY

HEALTH RECORD

DATE TIME BLOOD PRESSURE PULSE MEDICATION

CHANGES

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

CHECK DAILY

AFIB ZONESWhich AFib Zone are you today? GREEN, YELLOW or RED?

ALL CLEAR – This Green Zone is your goal-Green is GoodYour symptoms are under control. You have: • No irregularity of the heartbeat. • Pulse less than 100 beats per minute. • No bruising or bleeding. CAUTION – This Yellow Zone is a warning - ACTION NEEDEDCall your doctor’s office if: • No worsening of your irregular heartbeat symptoms. • Heartbeat faster than 100 beats per minute. • Dizziness or a fainting spell. • More shortness of breath than usual. • It is harder for you to breathe when lying down.

You have to sleep sitting up in a chair. • Feeling more tired than usual. No energy. • Dry hacky cough. • New or increased chest pain. • Feeling uneasy, you know something is not right.

EMERGENCY - Red Zone - Immediate Action Needed

Go to the emergency room or call 911 if you have any of the following: • Struggling to breathe. Unrelieved shortness of

breath while sitting still. • Have chest pain. • Have new confusion or can’t think clearly.

ACTION PLAN

NOTES

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