Understanding Risk in Afib

Hi guys,
Today i wanted to do a video on the subject of Risk in atrial fibrillation
Most people understand that there is an increased risk of stroke in atrial fibrillation but truthfully very few people really understand this concept of risk and not uncommonly when i speak with patients about anticoagulation, they say well i feel alright at the moment so can i not just see how thing go and i wanted to do a video to try and explain this concept of risk.
Risk is defined as the probability of something harmful happening.
So the first thing to understand is that there is very little relationship between how you feel and what your future risk is.
Have a look at this diagram.
Here is a man who is just leaving home to go walk to work. There is a manhole on his way to work. There is little relationship between how he is feeling as he says bye to his family and whether or not he will fall into the manhole and therefore it is a mistake to confuse how you feel with your risk.
A person with daily migraines may feel awful all the time but may live till they are 90.
A person with a brain tumour may not feel anything at all and have a great quality of life but may die within a few weeks or months
So when you are contemplating any treatment it is very important to understand what medications are being prescribed for your quality of life and what medications are prescribed to reduce your risk and not to confuse how you feel with your risk.
None can tell you exactly what your risk is of anything.
However it is possible to study a population of people just like you and work out the risk of that population by following them up and seeing how many people suffer harm over a set period of time and from that it is possible to give you some sort of idea as to what your risk is.
What controls the size of the manhole in atrial fibrillation:
Age and as you are getting older every year the manhole will get bigger too every year
comorbidities such as Diabetes, high blood pressure, heart failure and vascular disease.
Atrial fibrillation itself doesn’t probably make the manhole bigger..rather atrial fibrillation is probably like a hazard sign alerting everyone to pay attention to the manhole. We know this because patients with atrial fibrillation who are young -less than 65 and who dont have any comorbidities have a very low risk… but people who have comorbiditeis even with out Afib have a much higher risk so in essence the Afib is a marker rather than a cause of increased risk and this is why it doesn’t matter if the Afib is present or not, the manhole still exists and is always going to get bigger because the size of the manhole increases as age increases.
There are only 2 things that you can do about the increasing size of the manhole
You can reduce significantly the size at which it is getting bigger by paying attention to lifestyle.
You can partially cover the manhole by taking anticoagulants - 60% - Anticoagulants will not affect hw you feel..they simply work by reducing your risk.
Aspirin will only cover it by 20% at most - unfortunately the bigger the manhole, the thicker the manhole cover and then there is a risk that you could trip over the manhole cover and bleed
So in essence here are the main messages:
Do not confuse how you feel with your risk
Your risk is governed by your age and comorbidites and not by the presence or absence of AF
Your risk can only ever go up and therefore there really is no merit in waiting
Anticogaulants will reduce your risk by 60% but carry their own risks
Lifestyle modification is always worthwhile because it will not only stop your risk from increasing but has no side effects and will also make you feel better.

[@dr.tawfik9551]

AFib is not fun. it is not just pointed to the risk but it's also affected my quality of life...dizziness, headache, fatigue...thank you so much for posting this video on this very important topic.

[@jeanettespary2615]

What wonderful human being you are! Thank you…it’s scary with aAFIB an being 76, but you have clarified so many questions and it’s soooo reassuring. Thank you.!

[@SandraPaulsenPhD]

Many cardiologists think more about risk than quality of life. That may be understandable because they have patients who are cardiologically “on fire,” but others of us not on fire but just uncomfortable tho safe. Heart docs are in the business of life and death. However, Dr S.G. discusses both, which is humane. We aren’t supposed to just ignore or live with a pounding heart. Be still my heart! So thank you.

[@pjfreeman4789]

Thank you so much for this video and all of your videos. I was diagnosed a few months ago with AFIB. The cardiologist prescribed medications, but told me almost nothing about AFIB. I remember asking if my excess weight caused it and he shook his head no, without taking his eyes off the screen of his lap top. Then what does cause it, I asked. Age, was his reply. Our meetings last about 15 minutes, so there really isn’t time for education. So, thank you, again for the great service you provide. (Georgia, USA)

[@carolefaithorn7209]

That's a really clear explanation. The manhole analogy is great. Thank you. Hope you get some rest though as you look worn out, poor guy!

[@suecondon1685]

Love these videos, to find a Cardiologist who actually cares and is trying to help us sufferers - wonderful.

[@ericag2233]

This is fabulous!

[@avrilabbott9841]

Thanks for the presentation. I am not on any medication at the moment and am due to see a consultant tomorrow about my afib. I had a catheter abalation about 4 years ago which worked for a short while. Because I was feeling better I thought my risk was lower and was all set to dismiss any medication that may be offered to me tomorrow. After listening to your presentation I will be more realistic when discussing my afib with my consultant. Thanks again.

[@williammarotta3441]

Excellent video, thank you.

[@bntuthi1387]

Dr. You’re the best ! I listen to your video almost every day, trying to understand my condition. Thank you very much.

[@fionaguertin481]

SO helpful -THANK you for explaining so we can actually better understand this confusing condition!

[@YorkCardiology]

thank yoU!

[@averageguy53]

I think you did a great job in explaining!.....and really got a kick out of your handmade visual aids!!!! Thank you very much!!!!

[@lauraporter3434]

Direct, honest and relevant information - believe it! I had a massive stroke at 53 (no smoking or drinking & no diabetes). Then I was diagnosed with Afib. with a healthy heart. Possibly hypothyroid med contributed, along with overweight and stress. Miraculously, I completely recovered and better understand why I need to be more aggressive in self care from your videos. Thank you sincerely! btw I take Xarelto but fear getting a brain bleed.

[@robertsmentkowski312]

Six years later, how are you? I’ve been on Xarelto for six years and I snow ski, hunt, mountain bike and hike, sometimes even falling and getting cuts. So far so good.

[@peggymicsky8607]

Thank you, Doctor, for your information about AFIB and its treatment. So glad to know about the medications and the risks, and most of all, the behavioral things that can be done to combat it. It gives one hope. 💕

[@tessagunputh8972]

Very well explained. Thank you. I’m going to send to friend in Oz who has recently been diagnosed with AF. Your information is always lucid and accessible

[@omgimcool1231]

Appreciated the manhole analogy. So clear and concise. Thanks! Love your videos. Keep them coming.

[@MikeSneen]

Thank you for the great videos!! I have AFib and take Sotolol. I started getting it about a year ago, and initially controlled it with Vagal breathing. That worked for about a month, but after that I ended up in the ER unable to control it. The doctors diagnosed AFib and put me on 160mg Sotolol. I researched the subject and watched a number of videos, many of them yours. I started taking Magnesium Taurate, sitting and standing in better posture, and meditating more. I was able to get my daily Sotolol dose down to 80mg a day with that. I bought a Muse S biofeedback headband and was able to get it down to 60mg a day. I've been noticing that breathing seems to affect it. I tied that in with an article I read saying that the heart beats irregularly with lack of oxygen. I'm a software engineer, and I tend to breath really shallow and slow when I'm not exercising. I've experimented a bit with Wim Hof breathing. I'm going to experiment more and see if I can get my Sotolol dosage even lower. Has anyone else reported results like these, or any natural methods I haven't thought of?

[@SonGoku-zr9nc]

I am 28 male and have afib every 2-3months an episode lasts only 10-30 seconds but VERY symptomatic i nearly faint especially when it lasts 30 seconds. But what i do when i have an episode is i cough and jump off like when someone scared me (jump scare) it works because i give my nervous system a shock and the afib is gone. I am completely healthy and have vagally induced afib so i think it only works for people with vagally induced afib or lone afib. Sometimes when i have water with me i drink it very fast just 1-2 sips that helps too when i have an episode

[@ferneche]

Awesome video.......A very important subject.

[@YorkCardiology]

thank you!

[@brendanglennon7814]

Terrific Dr,great analogy,thank you

[@brucesnyder690]

Thank you Dr Gupta. You're amazing.

[@skl6955]

very good examples and thanks for the info. a lot of people see afib as a very dangerous heart arrhythmia, and in some cases it can be, but like you said your risks depend a lot on age, and other health problems. I was diagnosed with afib at 24 and ive only had 2 episodes, apparently from vagal nerve stimulation from vomiting. if people would get educated on afib it becomes less scary, because you start realizing your risk factors. I would like to say, if your doctor advises a course of treatment, take it, no matter how you feel, he went to school and learned a long time, so he knows what's best for you. luckily for me at the moment no treatment is needed, but that's not to say that I won't need it in the future, especially if I develop afib let's say without stimulating the vagal nerve, and at that point I will listen to my doctor and do what I have to so I can live a full life free of complications.

[@blakemoore666]

SKL, have you had another afib episode since the first?

[@annkelly4646]

Excellent video a wonderful doctor

[@lisabriggs2981]

Thank you Dr Sanjay Gupta, l am on Eliquis and nifedipine. And l.will be seeing my cardiologist soon. In the meantime l am trying to eat properly and l go to water aerobics. Now l know l need to walk more. You have been an answer to Prayer. Happy New Year.

[@tonym6920]

Well done Doctor, great presentation!

[@lzalton]

Thank you for your excellent talks on afib; they are helping thousands++!! It is difficult to know and talk about everything affecting afib. Some supplements also thin the blood. Someone who takes supplements to be healthier can have better results in afib than those who dont take proper supplements for their situation. The risk measures do not include quality of sleep, diet, time and duration in afib, etc. I hope some day you will help develop some enlightenment on these risk factors.

[@YorkCardiology]

thanks Larry.. i am planning to do some videos on this

[@Josh-pe5pl]

Enjoyed your metaphors. Explaining risk isn't easy. The whiteboard helped,

[@YorkCardiology]

thanks Ivanlese :-)

[@gregoryabbot420]

At first the manhole analogy seemed a bit strange. But it turned out to be an outstanding one for the subject of risk.

[@mikehiles3490]

Answered a lot of questions thanks.

[@joyceelmer131]

Thank you I understand the benefits of anticoagulants better now.

[@julcan1987]

So far, I haven't been prescribed any medication, and I'm taking coenzyme q10, magnesium and vitamin c.

[@luciadiaconu6687]

Thank you for posting this video it is close to my heart. I had a stroke because I stoped taking Prodaxa and did not replace with something else .You are right to take an anticoagulant.I had a stroke riding the bicycle.I love animals too and I wold like to contribute but I did not understand where.please go slower when you give us a Facebook chat I would enjoy that too. Thankfully Llucy from Florida.

[@loisdonnelly5842]

Thank you so much. You must put in so much time making these videos. You explain it all so well.

[@wendydrucker2708]

an amazing job at explaining

[@rubbishsignup]

Another very reassuring video.

[@YorkCardiology]

thank you!

[@afzalanwar136]

Thanks for very very use full and informative video thanks doctor

[@cnasaraha.2140]

hey Dr. sanjay, thank you for another great video, you always find such good ways to explain what your talking about. (I'll always remember) all the best to you too, and good luck with everything you do!!😍😊 ps. there are apps that measures the heart rate but I heard that they only give an idea of what the measurement would really be, and now there's a new one called Alive core, that comes with electrodes that go on the chest and a piece to put two fingers on and it takes the measurement. and then we can send it directly to the cardiologist. but how do we know for sure how accurate this new app is that cardiologists are relying on, for all their patients to use, and how do we know if and when a measurement is serious or not ? is this something you can do a video about ?

[@Myspiritualrhythm]

I had a strange problem where my heart felt like it was slowing down after lying on my bed at night. One cardiologist said, "squeezing?" I guess. But more like slowing. I was running 100 miles a week plus had two jobs. I was on my feet all day. I had to learn when some athletes say they run 80 or 100 miles they have desk jobs. It's important to understand this. I'm still not sure what's wrong. It's been over a year. The slowing went away but now I have some pain occasionally very low under my ribs. One doc thinks it's acid reflux, another thinks I'm allergic to roaches; my cardiologists said my heart was fine but some ultra runners on quora said they can't catch MY KIND of AFib. They suggested that I had a standard Afib test and that I might need a similar test over night.

[@snowy_beautiful]

superb video and advise

[@bossladywesley228]

Listening Aug 2020 and I really like the way you explain it!

[@peterwhyte317]

some years ago, I consulted a heart surgeon about my stroke and TIA's extending over about 40 years. He suggested a procedure on the left atrial appendix, on the basis that during the reduced blood circulation during at-fib an increased probability of clot formation occurred, leading to stroke. Is this opinion no longer held? I refused the operation. Also, is hypertension a cause of- or a risk factor for at-fib? Thank you for your clear explanations, which I always watch.

[@riskybizness00]

Excellent video. Thank you

[@Wilf-]

Thank you for your videos they put my mind at ease and you explain things so they are easy to understand.

[@fredericnicholson80]

First of all, thanks for all the info. I recently was diagnosed with AFIB. My doctor suggested a treatment with operation, but he then agreed to see if life style change can control it. To monitor, he suggested a under the skin monitor. To my surprise, this procedure will cost me 2000 dollar. Now my question can you detect AFIB with a smart watch with continuous heart rate monitoring on the rist?

[@bossladywesley228]

I am using some cheap smart watches and they are not accurate as the ekg or the regular blood pressure monitor. The expensive $200 one I have not tried.

[@timorourke9072]

Very useful. Thank You very much

[@Eyes-of-Horus]

One of the problems with having a good diet while on warfarin ("rat poison") is that it limits what you can eat. I enjoy vegetables like salads that have a lot of greens. But green veggies contain Vitamin K, a known blood clotting factor. I'm one of those weird people who like broccoli, Brussels sprouts and spinach. But can't have any of it without disrupting my INR readings. The newer anti-coags (Eliquis, Predaxa and Xeralto) have problems such as bleeding in the brain or other parts of the body, having to make sure it is taken 2 times a day (they have a half life of 12 hours) and in the U.S. the cost (over $450 per month). So, limiting what I eat is a problem. I don't like red meat but do enjoy fish (salmon is a favorite) and chicken and turkey once in a while. I am then taking supplements to help keep my internal homeostasis functioning in some kind of normal range. I would love to be able to get away from having to take any anti-coagulant (and especially that rat poison). Seems that the Watchman Device is useful in that instance. Hopefully, I can find a way that this can be done and I can finally be free of the chemical chain that binds me.

[@robertsmentkowski312]

I’ve been on Xarelto for six years and I snow ski*, hunt, ride an ATV, hike, mountain bike and road bike. I have fallen and been severely scraped up a few times without any unusual bleeding. Since I am a slow healer anyway, Xarelto should be a concern for me. However, so far so good even with all those injuries. * in my most recent doctor visit, she said that, since I am 67, “don’t ski over 50 miles an hour. Don’t try to keep up with young kids.”

[@Sand24]

Super fantastic🖒liked the stick figure💃thanks once again!

[@danielstapler4315]

Nattokinase or Apixaban? Which one should I chose?

[@dawnschubert1]

Still love your videos! You are awesome!

[@Otiesh]

I have been following your videos time to time and Honestly they have changed my life. I suffered from palpitations time to time and each time they come I noticed my blood pressure increase. I abandoned future plans in my life due to those on and off heart problems because at some time I did not expect to make it for another day. But due to your presentations I have gained carriage and feel much much better . I have actually been living with fear which kept worsening my episodes.

[@YorkCardiology]

aww thanks otiesh!

[@SonGoku-zr9nc]

Hey Dr. Sanjey, what do you think of the supplements natto kinase and bromelain as blood thinners?

[@diliakidd1851]

Does a person get congestive heart failure after having AFib for a year or longer….. If so why.

[@dawnschubert1]

Is there a study of how many people pass due to the coronary artery spasm? How does my Cardiologist decide that I am at high risk for sudden cardiac death due to this condition?

[@edwill1595]

I've had two afib episodes this year... but I get occasional palpitations... especially at night when I'm lying down...

[@MrPhatbody]

Are you on blood thinners??

[@neviafrleta7403]

Helpful video, thank you very much, bur it's a rather depressing condition. I wonder if you also researched natural ways (eg herbal medicine) to manage Afib.

[@grahamstewart8636]

I really appreciate your videos. They address many questions that have bothered me. I have Afib and am taking blood thinners and heart rate medications. I worry about the anticoagulants as I am diabetic and have developed retinal bleeding. It can leave my sight completely compromised for months at a time. Is the use of the anticoagulants still recommended under these circumstances?

[@gloriamaryhaywood2217]

How are you doing now? Did the retinal bleeding stop? Are you still taking the blood thinners?

[@emilylyons2683]

I’m a little confused. Are you saying that it is just the risk factors that cause stroke or risk factors plus a fib?

[@itfditfd]

So, if I did not have a fib, but my cormorbilities are 2-3, I should still be on a anticoagulant. Am I correct.

[@C02045]

It seems from a risk perspective the co morbidities represent risk but no one seems to explain how the atrial fibrillation is precipitated or prevented from being a harmful event in its own right, or just a trap for the unwary. How many co morbidity events are avoidable by lifestyle improvements or does the ones clock finally chime!

[@bobbimanuel7743]

hi doc. can you tell me the normal interval between heart beats. for example mine are. 0.83, 0.91, 0.85, 0.73 of a sec... it. varies is that normal?

[@C02045]

It seems from a risk perspective the co morbidities represent risk but no one seems to explain how the atrial fibrillation is precipitated or prevented from being a harmful event in its own right, or just a trap for the unwary. How many co morbidity events are avoidable by lifestyle improvements or does ones clock give its final chime!

[@michaelharrison2775]

I had a triple bypass a few months ago later on I was prescribed Eliquis and on the label that said for AFib but I was I'm not aware of ever being diagnosed with Afib and no one discussed it with me and I don't have any symptoms of AFib I didn't have symptoms of a heart attack when when they convinced me to get the bypass but if I have afib I'm I've had a stroke and I'm scared of having another one I understand about the pulling of blood in the ventricle or sorry I don't know my geography so I'm wondering if I can if I if a clock can be discovered in the heart via ultrasound and then by this means had it off of the past instead of living from day to day taking a chance that something might go up my carotid artery

[@michaelharrison2775]

Just surviving this stupid Google speech to text is going to be a miracle this is frustrated me and and put wear and tear on my heart and taking yours off of my life you stupid ass program can't do a damn thing right

[@irisread3448]

Can you take paracetamol whilst having afib 3:45

[@sakina9w962]

It is v knowledgeable vedio all the time, I am new in your group and need your advice, if you have any num I can contact you . Thanks great job.

[@2manycatsforadime]

Watchman?

[@beanprophetbeanplsworshipm3987]

Does Afib has to be fast or does Afib can be slow? I felt like i was having an Afib episode the other day, my heart was beating irregularly for more than thirty minutes, the irregularity goes like that: two fast beats, follow by a skipped beat, followed by three or four slower than normal beats, then a few more faster beats, then back to normal until the same cycle happens again a few minutes later. I went to an urgent care, The doctor there dismissed it as nothing as he claimed since my BPM was in the normal range 60-100 it wasn't AFIB. Does the beats has to really fast to constitute AFib or the AFIB can consist of slow bits too?

[@danielobrein6496]

magnesium and calcium deficency ----cayenne pepper

[@danielstapler4315]

Nattokinase or Apixaban? Which one should I chose?