BIO: Heart Beat Now
Dr. Paul Dorian is the Department Director, Division of Cardiology, University of Toronto and Staff Cardiac Electrophysiologist at St. Michael’s Hospital. He is Professor of Medicine in the Division of Cardiology and in the Division of Clinical Pharmacology at the University of Toronto, and a Staff Scientist at the Li Ka Shing Knowledge Institute.
Dr. Dorian received his medical degree from McGill University in Montreal in 1976. He continued training in Internal Medicine and Cardiology at the University of Toronto, and received certification by the Royal College of Physicians and Surgeons of Canada in Internal Medicine in 1983 and certification in Cardiology in 1984. He completed training in Clinical Pharmacology at the University of Toronto in 1982, and received an MSc in Pharmacology from the University of Toronto in 1982. From 1983 to 1985, he completed a Fellowship in Cardiac Electrophysiology at Stanford University Medical Centre in California.
Patients often ask me: I have atrial fibrillation, should I be worried about lifestyle, are there things I should do or I shouldn’t do? The most important thing for patients to understand about atrial fibrillation and lifestyle is as follows.
First, coffee is safe in atrial fibrillation, there’s no reason not to drink coffee, and the scientific evidence if anything shows that coffee protects you from atrial fibrillation, doesn’t cause atrial fibrillation. Of course, if you drink too much coffee it can cause anxiety or palpitations, but it has nothing to do with the atrial fibrillation.
The second question importantly is about alcohol. Alcohol in excess definitely can cause atrial fibrillation, and all patients with atrial fibrillation should avoid alcohol in excess. Small amounts of alcohol, for example, one standard drink or one or two glasses of wine a few times a week are not harmful, they’re not a problem, and you can safely have alcohol as long as it’s in moderation.
Exercise is safe in atrial fibrillation. Of course, if you’re exercising, riding a bike or running or doing a sport and you have atrial fibrillation and you’re dizzy or you’re short of breath then you need to slow down or perhaps stop. But for most patients, regular activity and exercise is perfectly safe.
You can play sports, you can go for walks, you can play tennis or whatever is your favourite activity. You’re able to do it, furthermore, the more exercise you do, the less likely it is you are to have atrial fibrillation recurrences for most patients. Exercise is recommended, and it is safe under most conditions; if you’re not sure, ask your doctor.
Let’s talk about diet and atrial fibrillation. Atrial fibrillation is not directly related to diet, in the sense of the kinds of the foods that you eat or the supplements or vitamins, it really doesn’t matter. It is absolutely true that patients that are overweight or obese are more likely to develop atrial fibrillation and it’s going to bother them more than individuals that are of normal weight.
Very good research tells us, that if you have atrial fib and you’re overweight and you manage to lose weight, largely through diet and exercise, you will have less atrial fibrillation, and you will feel better, and be less bothered.
Lastly, patients often tell me, stress is something I want to avoid, I think my stress level is high, should I be worried about stress and atrial fibrillation, and the answer is stress does not cause atrial fibrillation. Of course, if you’re stressed and you have atrial fibrillation it will bother you more. Anything bothers you more if you’re stressed. But stress by itself doesn’t cause atrial fibrillation, and avoiding stress, although it’s of course a good thing, will not prevent you from having more atrial fibrillation.
So the bottom line is if you have atrial fib you can just lead your life as normally as you can. You may not be able to do everything you would like to be able to do, but there’s no reason to restrict your life in terms of diet, in terms of activity, in terms of alcohol – in moderation, in terms of coffee. Just lead a completely normal life.
If you have atrial fibrillation and you don’t feel well, or you need more information, or you’re not completely satisfied with your treatment, speak to your family doctor. If needed, ask to be sent to a cardiologist who has expertise in atrial fibrillation, and get yourself as well informed as possible about this condition so that you better understand your own body and you can deal with the symptoms more effectively
Stroke is one of the most feared complications of atrial fibrillation. About one in every five strokes in North America is caused by atrial fibrillation, and if you have atrial fibrillation, your chances of having a stroke are about sixfold higher than in a similar person who doesn’t have atrial fibrillation.
Most strokes in atrial fibrillation unfortunately, lead to permanent disability from paralysis or inability to talk, or walk or speak. Stroke in patients with atrial fibrillation is caused by blood clots, which form in the heart and then dislodge and go to the brain, stopping blood from getting to the brain cells, and when brain cells die, you get a stroke because your brain doesn’t function anymore.
Anticoagulants are sometimes known as blood thinners. They’re not actually blood thinners, what they are is anti-clot agents, and these are drugs that prevent the blood from clotting when it is in the heart.
It’s important to know that the blood still clots, even if you’re on an anti-clot agent. So people don’t bleed to death; they are more likely to bleed if they cut themselves, for example, but these anti-clot agents are basically very effective at preventing these clots from forming in the heart, and then dislodging and going to the brain or other organs.
There are different kinds of anticoagulants, known as blood thinners, that patients and doctors can use. The choices are generally made between patients and doctors after a discussion, which we call shared decision making.
The traditional blood thinner, which has most frequently been used in the past, is called Warfarin, sometimes known as rat poison. Warfarin has been around since the 1950s, and it is very effective at preventing clots and reducing the risk of stroke.
Unfortunately, Warfarin is a complicated drug to take, and there are now – in North America and worldwide – at least three and soon four other newer blood thinners, so-called novel oral anticoagulants, are taken once or twice a day, and do not need monitoring.
In other words, one size fits all, so to speak, and the doctor makes a decision as to what the right dose is for that particular patient, and the patient then takes the medication and is followed up by their doctor. Usually every six months or as infrequently as every year.
It’s very important that patients have a detailed discussion with their doctors and their pharmacists to make sure that they’re taking their medications appropriately. It’s important to know that medications only work if you take them regularly, exactly as instructed.
Missing doses or stopping the medication – even temporarily – can put patients at risk for stroke. This is a conversation that is very important to have with your family doctor, with your cardiologist if you have a cardiologist, and your pharmacist to make sure that you’re taking the medications exactly as recommended in the right time frame, and that you don’t miss any doses. This is an ongoing challenge for patients and for doctors, to make sure that the medicines are taken exactly as they’re supposed to be taken.