HVC Podcast
Heart and Vascular Care is a leading cardiovascular practice in North metro Atlanta and North Georgia. Its focus is the outstanding diagnosis and treatment of patients in all of its 12 offices. Areas of specialization include interventional cardiology, peripheral arterial disease, venous disease, and electrophysiology. The purpose of this podcast is to educate medical and cardiovascular providers in the contemporary and practical treatment of cardiac, peripheral and venous disease patients.
HVC Podcast
Special Episode: Dr. Amier Ahmad, Live on The Weekly Check-Up Atlanta
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In this remarkable crossover edition of the HVC Podcast, we're excited to shine a spotlight on our own Amier Ahmad, MD. Recently, Dr. Ahmad joined Dr. Bruce Feinberg on "The Weekly Check-Up" radio show, where he discusses how the body indicates an underlying electrical or vascular problem and the ways modern medicine can help stabilize these systems.
As an Electrophysiologist and General Cardiologist, Dr. Ahmad specializes in the intricate "wiring" of the heart. His expertise focuses on diagnosing and treating complex cardiac arrhythmias (irregular heartbeats).
If you have any clinical symptoms or medical questions, please consult a licensed healthcare provider.
SPEAKER_03Welcome to the weekly checkup. We're presented by Wellstar Health System. I'm your host, Dr. Bruce Feinberg. And we're talking about hearts this week. And I know you may think, you know, I've heard a lot about hearts in recent months, and you should. Hearts are a big deal. In terms of reasons that people are ill, reasons that people lose their lives, heart disease remains kind of the number one. And there's so much to talk about and so much we haven't talked about. And we're going to get into hearts again today, but we're going to be talking about things maybe that we haven't gotten to ever, or in certainly a long time. One area in particular, and I think everybody has met knows someone they're one degree away from someone who has passed out, fainted. The more technical term that we use in medicine is called syncope. And whatever term you're familiar with, you probably get the fainting, the passing out. And often, you know, these people will uh kind of come around quickly. Um you think about things like, you know, their blood pressure or their blood sugar, and those can be, but probably more common than anything else is an irregularity of their heart rhythm. Maybe it got irregular and it wasn't pumping and the heart wasn't pumping enough blood. Maybe it got too slow and the heart wasn't pumping enough blood. But syncope is just one of those really common things, fainting and passing out, a really common thing that people don't necessarily associate with heart disease. And we're going to be talking about that today. Now, there are a lot of familiar things that people associate with hearts and irregular rhythms, or maybe they don't know, but they've heard about diseases like atrial fibrillation or AFib because they see commercials. I don't think you can watch television for two hours and not see a commercial for a drug about AFib. And these drugs don't even treat the heart. They treat one of the complications of AFib, the blood clots that form. And why would that be? And that's another big disease area that we don't think of. When we think of hearts, we typically think of heart attacks, and that's the most common thing. But hearts have are very complicated. They they, in some ways, they're elegant in their simplicity, and they're in other ways they're incredibly complicated in terms of incorporating all the different aspects of anatomy and physiology to do their job. So it's going to be, I think, a very interesting show. Hopefully it'll be a lot of fun. We'll cover a lot of ground. And as always, we want you to join in. Our best shows are the shows where you, the listeners, get involved. Tell us your stories. Tell us what has happened to you. If it went well, if it didn't go so well. Sometimes you don't know this the answer to the story because the story's just starting. Um, it may be your story, maybe the story of a loved one, a friend. It may even be a story in a way that's related to something you've read about, heard about, and doesn't directly involve you, but you think it may someday. So give us that call, 404-872-0750. As we always do, or certainly we like to do, is have an expert when we cover a topic like this. And we have our expert in the studio with me. We're live here at WSB in Midtown, and it's Dr. Amir Ahmad of Heart and Vascular Care. Now, we've talked before about as medicine has gotten increasingly complex, and that complexity was driven by our greater understanding, the heart and its complexity became a lot for any one doctor to manage everything with the expertise and gain the experience needed to really offer optimized care. And so in order for medicine to evolve as it needs to, areas like cardiology become start start to get sub-specialized. And so now there are doctors who just deal with these irregular heartbeat situations. And those are called elect they are called electrophysiologists. So not always the best words. I wouldn't call them plumbers because plumbers you think of as things going through pipes. These are more like electricians. They're mapping out the electrical impulses that allow the heart to beat regularly or to understand when it's not. So Dr. Ramad is an electrophysiologist as well as a general cardiologist. So all these subspecialty trainings take place after they get their background training in internal medicine and then in general cardiology. And he focuses on the treatments of these complex irregular heartbeats, which are called arrhythmias. He completed his cardiology fellowship at NYU in New York, and he served as chief fellow. And um he did his electrophysiology fellowship at Honor Health in Scottsdale, Arizona. So we'll have to understand why he left Scottsdale. Seems like everybody wants to go there. And he came to Atlanta, where he also served, though, there in Chief Fellow. And I don't know if I ever shared this, but and we didn't have a special handshake. But I was chief fellow when I was in my training for my fellowship in oncology at MD Anderson. So we had the chief fellow thing going on. We're not gonna let it get to our heads, we're gonna still be just regular guys here as we have our conversation. Um, we're gonna talk about not just the drugs, but also implanting devices into the into the body to help control um the abnormal rhythms. And we're also gonna talk about how using new techniques we can actually destroy the pathways that generate the abnormal rhythm. So that's called ablation treatment, and that's a lot more to talk about. So we've got all kinds of things to cover from the standpoint of how it impacts you passing out or blood clots related to AFib, to what actually are being is being done to treat it and understanding a little bit of that more complex physiology. And to learn more about Dr. Ahmad and the rest of the practice, go to HVCMD, HVCMD.com. And once again, you can be part of the conversation, 404-872-0750. Amir, good to have you here.
SPEAKER_01Yeah, thanks so much for having me.
SPEAKER_03All right, so I often uh when we have a first timer, as you are, on the show, love to have the audience kind of get to know you a little bit. And I always find it fascinating, kind of beginning with like, when did you know you wanted to be a doctor? And I don't care if it was when you were three years old, but I want to know when it happened, how it happened, and then how that journey from a starting point took you into cardiology and then electrophysiology and finally to Atlanta. So take it away.
SPEAKER_01Yeah. Uh so I was actually born and raised in Florida. Um, my parents still live there. And I knew pretty pretty early on that I wanted to be a doctor, um, mainly because I always sort of liked helping people. I thought being a physician would be pretty cool in terms of what you can offer. And so going into high school and college, that was sort of what I wanted to do. It wasn't until I was in medical school that I sort of had a better understanding of the different different specialties, and cardiology always really kind of spoke to me, uh, mainly because it is one of the broadest specialties in terms of what we can offer. We have pills for issues that people can deal with, but we can also do procedures. Uh, you can be reading images, you can be directly in the cath lab putting in a pacemaker. So it offered a lot of variety. And for me, that was very, very interesting and something that I was drawn to. Uh, when I was in New York, uh, I thought I could be a general cardiologist. I I graduated and and actually worked here in Atlanta for two years before deciding to go back to be an electrophysiologist. And I love general cardiology, but I will say I think doing procedures is just more cool than anything else. So, you know, I think that that ended up kind of driving.
SPEAKER_03I think the other aspect is the instant gratification.
SPEAKER_01Yes.
SPEAKER_03You finish that procedure and you fix the problem.
SPEAKER_01Yeah.
SPEAKER_03It's really different than putting patients on meds and watching them over the next few years. And were they able to adjust their lifestyle? Did they tolerate the meds? You know, it's like it's really very different. I think everybody loves the instant gratification. And for years, that was always the surgical route. And it wasn't until recently that you could be in a medical specialty and really follow patients throughout their entire health history and also do those kinds of cool procedures.
SPEAKER_01Yeah, 100%. I think electrophysiology is nice because I can still see patients in the office continuously for their for their issues, but it is very gratifying to take a heart rate that is low and then fix that immediately. And that is very fun.
SPEAKER_03Yeah, I can't imagine, like, you know, again, it's so different than when I was started in medicine. So much is so different than when I started in medicine. Let's pause on the background in history because we've got a caller. So this is one of the earliest calls we've had on the show. I think we have a call. We have we have rarely received a call in the first five minutes. This one came in just about five minutes in. And so let's talk to Dan. Hey, Dan. Hey, how are you doing, Doctor?
SPEAKER_08Thanks for taking my call. You're very welcome. Um for a Christmas present, I got one of these aura rings, and uh, it's a remarkable technological device that measures breathing, blood oxygen level. There's there's more variables than you need to know what to do with. One of the things that measures is heart rate variability. And uh I think I understand what that means, but the uh the point is uh it runs between 23 milliseconds and 40 milliseconds, and our trainer says it really should be between 50 milliseconds and one second. The only other uh variable that I mean to add is I have a very low heart rate, uh typically high 30s, low 40s. So I don't know if that has a uh an impact on heart rate variability, but I'm just worried is it is there a problem because my number's too low?
SPEAKER_03All right, so like Dan, you just like opened up like Pandora's box here of all these different things to cover, beginning with the aura ring. I I've got to know, do you have an Apple Watch? Yes. Not you, not you. Oh no, oh no. I'm gonna say about it. It's his first show, guys. Give him a break. I do not know. And did you did the family not want to get you? It's just like if you want all these things to do, you know, to watch and to study. I mean, an Apple Watch has been, you know, available now, I guess, for about five years, where you could get a single lead rhythm and you could follow it on your watch, where you can actually see the rhythm and not just you know be able to download it later when you take the ring off.
SPEAKER_08But right, well, you can actually see the rhythm on the ring. On the on the app, yeah.
SPEAKER_03Oh, on the app, right, okay. But you don't have to take it off, you can just watch as you're doing it.
SPEAKER_08That's that's right, yes.
SPEAKER_03Okay, so um anyway, so but I was just curious, like, are you a real are you an engineer kind of guy and a techie guy?
SPEAKER_08And you know, yeah, yeah, yeah, yeah, and and a man, a cardio guy. I've been doing cardio for 60 years.
SPEAKER_03All right. All right, so um we're we're gonna have to go to break, but it's all fascinating. And and I I know that Ahmad does not need a lot of time to answer any of your questions. So this is not a punt, so we can go Google everything you just said. Um, but I do think we'll be talking about it because I think it does raise lots of questions. And and it's a fascinating issue for me because what we're doing is we're creating these devices that are giving people much more information than they know how to use. And so the question is is that a good thing or not? Like, you know, so um uh anyway, it's you know, and then you get into the question of what are the limitations and you know, so you know, how it's great it can do these things, what's valuable, what's not, what could be scary because you might misinterpret it, and what do you you know, you're calling the doctor every other day. So I think there's a lot to this, and I want to get into it. And I so we're gonna take a break though, and when we come back, you'll still be on and we'll have this conversation. Stay with us. But if you like to produce our song of the week, if any of the songs you'd like to hear, we may start playing them as early as next week. We're back on the weekly checkup. We're presented by Well Star Health System. I'm your host, Dr. Bruce Weinberg, and our show is produced by Lens, Atlanta's healthcare marketing expert. We're live in the studio with Dr. Amir Ahmad of Heart and Vascular Care. We're talking all things heart, but with a particular focus today on heart rhythm. And which is why Stop Kicking My Heart Around was our song of the week. Give us a call, stay in the conversation. We're talking to Dan on the phone. You can join and get in the queue, 404-872-0750. So um, just to kind of remind everybody, uh, or for those who just tuned in, so Dan called because uh he was given an Aura A-U-R-A ring. And the Aura ring uh has a is a very interesting technology. It's like not much denser, bigger than a wedding band, but built into the frame of that band is a lot of cool technology that can do things like give you an understanding of your heart rhythm by giving you what would be like a single lead. Uh, that's too technical. We'll explain that. We have an expert here to do that. But the aura rings and other types of technology have really changed the way in which we can get feedback about our bodies. So I'm gonna get our expert on, uh, and then we'll get into some of Dan's more specific questions. But this is a short segment, and we may have to carry over to the next one to cover it all because Dan really did give us a lot to talk about and think about. All right, so let's start with medical devices in general, especially wearables.
SPEAKER_01Yeah, so right now on the market, there are several wearable options. So uh ranging from smartwatches to the RR ring. And then you also have the option for things that are attached to your phone that can give you the same type of information in terms of heart rate, uh tracings of the heart rhythm and these types of things. So in terms of the smartwatch and the RO ring, these offer kind of continuous uh information and can be worn throughout the day to give you an idea of heart rate variability, heart rate trends, but can also alert you to arrhythmias such as atrial fibrillation or AFib.
SPEAKER_03So I was just at dinner last night, and we had uh friends who've been friends for 40 years, um, and he's been diagnosed with AFib. And he's wearing his his uh Apple smartwatch and it's got an alert built in because he's never been symptomatic when he's in AFib. And because of that, he's on Eloquis a blood thinner because he doesn't know when he's in it, and it could go for too long and make him exposed and at risk of a blood clot. And we'll talk more about that. Um but it's not just like a game he can play where he can every day, like a certain time of day, sit down and you know, look at what his heart has done in the last 24 hours. Um but he actually gets an alert that tells him that you're now in this abnormal rhythm. For some people, that's critical in terms of steps they may have to take. But it is more than just kind of it's gone from kind of just a curiosity into I think physicians like yourself are actually using them as part of the care plan.
SPEAKER_01100%. Uh a lot of times patients will come to see me because the watch is their first alert, because a lot of patients with AFib don't have symptoms or any kind of arrhythmia. You may not feel it unless you get alerted on a wearable device.
SPEAKER_03And then when you do, ah, like I'm like, I got it. All right. So, all right, so we are gonna have to go to break. And so, Dan, there are other questions about you're getting readouts, and the readouts are they telling you that something's wrong because you also have a slow heart rate. And that brings up a type of condition called gradycardia, which is the Latin for slow heart rate. And is that something we you know should talk about? Because it's on my list today of the topics I wanted to cover. So, what a perfect opportunity to get do that with some of the others on the uh on the phone who can maybe respond to are they symptomatic? How was it found, and things of that nature. So we will be back. And I want Dan to stay with us, I want everybody listening to stay with us, and I want more calls to come into the queue, 404-872-0750. We'll be back. Our show is brought to you by Wellstar, and we're sponsored by All Care, offering preventive health and immediate access for your urgent medical needs. The Georgia Trauma Foundation, investing in trauma care to save lives, Alansky Dermatology and Aesthetics, offering the highest quality in medical, surgical, and cosmetic dermatology, Avant Gynecology, Alana's GYN and surgical specialist, and virtual imaging EBT screening for cancer and cardiovascular disease. We are live. We have Dr. Amada Mir in the studio. We're talking about hearts, and you can call us and talk about anything related to hearts, but in particular about heart rhythms. We've got Dan on now, and we've got Carol cued up, and we're going to get to both, hopefully, this segment. And so, for those who've been listening, Dan was recently given a present of an aura ring, and with it, he's been able to actually see his own heart rhythm or heart rate, as you might say. But it's not just the rate, it's the way that the heart expresses that rate electrically. And you may know that because you've seen those images either on TV shows where you see the monitors, and you can see the sharp lines that go up and down and continue across the screen. Um so we're gonna talk a little bit more about that aspect. And there may be some questions we're gonna have for Dan. So I'm gonna pass it back to our guest, and Ahmad's gonna kind of continue on both the wearable devices and other devices and then how they're being used, not just by him, but by other doctors and specific to Dan's questions about his heart rate.
SPEAKER_01Yeah. So uh, in terms of monitors, just to kind of wrap up the description, you have the option of continuous monitoring with things like the Aura ring and the Apple Watch or smart watches. And then you have intermittent monitoring with things called the cardio mobile, where you can get rhythm monitors uh that kind of show you what your rhythm is at a specific point of time. So I think, Dan, it sounds like you've got the AR ring and have been using it. And then the question of a low heart rate and heart rate variability. I I guess in terms of wearing it, was it just a gift that you were you were just kind of curious about in terms of what your heart was doing?
SPEAKER_08Yeah, no. Well, first of all, the thing uh the other piece of the puzzle that I've got to tell you about is I have a cardiologist who's seeing twice a year. He was concerned about low heart rate, bradycardia. So he ran me through a battery test. So I've had the uh stress test, stress gallium test, carotid artery, ultrasound, and also I've had a uh war heart monitor for two or three weeks. And he says everything's fine. Low heart rate. It's always been a low heart rate, 38 to 45 feet per minute. And I do work out, I do three, four, or five miles a day for 60 years, or that would be 75. So um the the the primary reason I got the order range is I wanted to get a quantitative measure of the quality of my sleep. And you know what you know, this thing measures deep sleep, light sleep, room sleep when you went to bed when you wake up. I mean, hiccups, yeah, there's just so much data. So one of the pieces of data that took off was heart rate variability. And we have a personal trainer. Yeah, what does it sound like 27 to 35 is too low? And I'm wondering, did my cardiologist miss something? Or is this just a little bit more?
SPEAKER_03Wait, wait, wait, what does your personal trainer do? What kind of background does he have to know this information?
SPEAKER_08Well, he wears he wears his own monitoring device. As well as I looked it up, you know, AI. I you know, I looked up what's your typical heart rate variability and I said it should be between 50 and 100. And he said his is always one one second. So, you know, I'm I'm you know, there's so much information available on the web through AI. Um keep reading here and give yourself a heart attack. But the question is, are we missing my cardiologist who's giving me a perfect examination? I'm extremely healthy. I have no symptoms whatsoever. I I can walk two and a half, three and a half miles up steep hills and uh since you're now monitoring your heart rate.
SPEAKER_03When you walk those steep hills, does your heart rate show that exertion? Oh sure. Oh, sure. Oh yeah. So so how fast will it go? Will it get up into the 140s or 120s?
SPEAKER_08Oh no, no, it never uh never goes more than one oh five, one ten under heavy exertion.
SPEAKER_03Okay. Interesting. All right, I gotta throw some things in there because now I'm curious too.
SPEAKER_01All right, well, so yeah. I think you bring up two two great questions, uh a low heart rate and then this concept of heart rate variability. So a low heart rate by itself is not dangerous. A lot of people, just like you, have had low heart rates for decades. And a low heart rate can be an issue if it doesn't quite keep up with the things that you do on a day-to-day basis. So for you, it sounds like when you are walking three to four miles, your heart rate does kind of kick up. And so, from that standpoint alone, I think a low heart rate by itself isn't indicative of anything that is necessarily dangerous. The second point of this heart rate variability, you know, heart rate variability refers to how much time is there in between each of your heartbeats, right? And so if you have a very low heart rate variability, Variability, it's a very rigid amount of time. There's not a whole lot of variability. Versus if it's a high number, then there's a lot of time between each beat. And conceptually, it has to do with recovery periods as well. But when you kind of reference that normal range, I want you to remember that a normal range refers to a general population. It's not all 75-year-olds, right? And so heart rate variability for 75-year-olds is very different. And so I wouldn't compare it to a normal reference. I think what I tell patients is heart rate variability is good for you to compare to your own number, meaning if you're interested in increasing your exertional tolerance and kind of working on your conditioning, it can be helpful to compare your heart heart rate variability now versus what it could be in six months and see if you are maybe pushing yourself hard enough. But it sounds like you're doing pretty well in terms of exercise and how much you're pushing yourself. But the variability itself is not indicative of, you know, how healthy or how unhealthy your heart rate is. It has more to do with kind of your starting point and where that number could go if you continue working with your personal trainer and maybe increase the amount of cardio or strength training that you're doing.
SPEAKER_08Got it. Well, that's that's a great answer. And I really, really appreciate your call and uh any additional knowledge and actually comfort that you've given me.
SPEAKER_03All right, so Dan, a couple things to keep in mind. If you want to do that additional research, given you know the kind of guy who I think you are from this call, I you can go like with these specific questions. If you just add to your search PubMed, you'll get the medical literature, which we'll do things like look at an issue by different age groups when they break down the populations into subgroups. And so just adding the word, because that the PubMed is the site, the kind of um what's the word? Kind of clearinghouse for all of the medical research. And it'll give you, I think, a higher level of content than you're gonna get from a Google AI answer. So that's one thing to consider. And then I still think you should have this conversation with your doc. Don't tell your doc he may know me that I said it because he may not want to talk to me again. But but I do think that these are things you want to talk about, you know, with your docs. So it's great we have somebody, you know, here and we can have this conversation, but it doesn't mean you shouldn't, you know, continue to have it. And with that, we will bid you a good afternoon. Enjoy the rest of your day.
SPEAKER_08Thank you guys so much. I really appreciate it.
SPEAKER_03Pleasure. All right, and let's bring up Carol. Hi, Carol. Thanks for waiting.
SPEAKER_05Hi, thank you for having me. Um, I had a stroke back in December. The doctors called it a level level one, but it was definitely a stroke. And as a result of that, the lowest our doctor had recommended me to have a T-SIM monitoring device put on, which I did, and I wore it for 30 days. There were something that was provided to you out of the male money. Um, there were no signs of any abnormalities, and when I was done with this, then they wanted me to do a device that evidently was put under the stand and you wear it for a year. And I asked why I would do that when I had no symptoms or anything else, and I have no pre-history of heart problems. Why would I be wanting to do this other thing for another full year? And I did not get a satisfactory answer. Can you answer this?
SPEAKER_03What answer did you get?
SPEAKER_05I basically it was just that it's for further monitoring, um, and it could be something that they missed during the 30 days that um you know it was totally up to me as to whether I wanted to do it or not. And I said, No, actually, I don't. I don't see I don't really see the reason for it.
SPEAKER_03And uh I'm gonna guess you're you're talking this is you're talking to a nurse at this point, or you're talking to the doctor.
SPEAKER_05Uh, I'm talking to the well, you know, I don't know. I was probably the PA.
SPEAKER_03All right. I I mean, I again, it's not not to be judgmental, but you know, given the level of your concern, it would have been great if that individual was not the doctor for them to say, look, let me have the doctor step back in because you've got still have some questions. And I would have liked to have heard that kind of response than the response you were given, which isn't necessarily a wrong response, but it wasn't a satisfactory response to you. And you're the patient, and you know, especially now it's a procedure that's being talked about. So I would have liked that. All right, off my soapbox. All right, um, Ahmad, so the bigger picture first for all the listeners, and about the history of halter monitors, and then what happens when you wear them and they don't show anything.
SPEAKER_01Yeah, so it, Carol, it sounds like you were hospitalized for what sounds like a stroke. Let me just ask, do they tell you what they thought caused your stroke?
SPEAKER_05Yes, it was a blood plot in the base of my brain, a very small one. I have had no residual effects. Uh, he said the chance of me having another one within the next five to ten years is like zero digits.
SPEAKER_01Yeah. And I assume that they put you on some type of mild blood thinner, like an aspirin or something like that.
SPEAKER_05Yes, uh a baby aspirin, 81 milligrams, I think, or something like that.
SPEAKER_01Yeah.
SPEAKER_05Um, yeah, that's what they've got me on, and that's it.
SPEAKER_01Yeah. So I so it sounds like you you had that hospitalization for a stroke, and what they were looking for on that Holter monitor for 30 days was what's called atrial fibrillation. And apib is an arrhythmia of the heart where it can beat irregularly and cause blood clots that can then cause a stroke. Uh, one in four people will develop AFib in the duration of their life. And what happens after a stroke, if we're not sure what caused that blood clot, one of the things that we look for is atrial fibrillation. I think what they were referring to after the monitor was what is called an implantable loop recorder. So the idea is that on day 31 or day 32, when you're not wearing a monitor, you can have AFib. And if you don't realize it, because sometimes patients don't feel AFib, it could increase your risk of having a stroke. And the big thing is, is when you have AFib, one of the things that we do is we put you on a different kind of medicine that's not a baby aspirin, that's a little bit stronger, a blood thinner, maybe called Eloquis or Zerelto, or these other names that you might hear, that's a little bit more potent to prevent blood clots. And so the idea is that they're worried that maybe over time you could develop or have developed atrial fibrillation. And that led to you having a stroke. And if they put in an implantable monitor, they can monitor for that. And if you were to develop AFIB, then they would change the baby aspirin to something a little bit stronger.
SPEAKER_03Right. And it goes from a one-month surveillance to a one-year surveillance? Correct. And if that still shows nothing, then you're done? Or is there then the five-year surveillance?
SPEAKER_01Well, so you know, uh, an implantable loop recorder monitors you continuously and it alerts us, the physician, if you have AFib, so that we can act on it. Because the downside is saying, well, we think you have AFib, let's just put you on a blood thinner, but then you have to be on a blood thinner for something that you might not have.
SPEAKER_03So we're just everything is about probabilities here. The nature of the stroke that you had and that little blood clot that was thrown, it is nine times out of ten coming from an AFib episode that was asymptomatic.
SPEAKER_01Correct. Yeah. And the idea is that if we can catch it on a monitor, then we can do something different. And so your point, Carol, is that well, what do I do after a year?
SPEAKER_03And so wait, I'm gonna, Carol, you're gonna have to hold. I hate to tease you, but you have to hold for that answer because we have to go to break and we will be back on the weekly checkup. Remember, you can get in cue after Carol, 404-872-0750. Make your call. We'll be back on the weekly checkup. I'm your host, Dr. Bruce Weinberg. Our show is presented by Wellstar Health System at Wellstar. The patient is at the center of everything they do. Wellstar is nationally ranked and locally recognized for its high quality care, inclusive culture, exceptional doctors and caregivers, and one of the largest and most integrated healthcare systems in Georgia. Thanks for tuning in. I'm joined with by Dr. Amir Ahmad of Heart and Vascular Care, a comprehensive heart care and vascular care practice. And we're taking your calls. 404-872-0750. Get in the queue. We're going to finish our conversation with Carol, and maybe we'll have time to start our conversation with David. We'll see, but if not, we'll get to him in the next segment. All right, so for those listening already or just tuning in, um, so Carol has been wearing a device. We used to call it a halter monitor. It was a 30-day monitor that would continuously monitor your heart rate and rhythm to look for things like episodes of atrial fibrillation. For her, the reason for this was she had a very small stroke and was very fortunate that it was a small stroke and appears to have not left her with any deficits. But the doctors are concerned that the nature of the stroke was likely meant it was caused by an episode of atrial fibrillation. And now the third AD monitor showed nothing, and they're suggesting a wearable device or implanted device that will be able to capture a year of data. And we were into that discussion with our expert who's here in the studio. So, Amir, kind of let's continue it with Carol.
SPEAKER_01Yeah, so Carol, I think we were talking about AFib and this risk of stroke. So just to tell you, you know, AFib can cause a stroke because when your heart is in AFib, it beats very irregular and very fast. And when it moves irregular and fast, that blood is not being pumped like it should in an efficient manner. And when blood pools, it it clots. And that clot can come out and go to your brain and cause strokes. And so the only way to really avoid that is one is, you know, maybe putting a device there that can prevent that blood clot from moving, something called a watchman device, or blood thinners like uh over-the-counter pills that can dissolve that blood clot. And so for you, I think the concern that your doctor had was that, well, maybe your stroke was caused by AFib. And if we monitor you long enough, we'll pick it up and change it to a blood thinner. And I think that that's a good, good line of thinking. You know, strokes are common, uh, and AFib is a very common cause of stroke. So, you know, I think, I think if I were you, I would definitely give some thought to maybe this implantable monitor because I think AFib is definitely preventable in terms of what it can do with blood clots. And we definitely don't want you to have a bigger stroke next time if we miss it.
SPEAKER_03And and the blood thinners, if you're going to take them for the rest of your life, they have risk. And the device, the watchman device, is a is a much bigger procedure than the one that's being recommended. So it's kind of everything they're telling you, maybe not with the explanations that were needed for you to give you that comfort level with that recommendation, but it all seems to you know match the standard of care.
SPEAKER_05Okay. Um, I let me add let me add one thing that um in October of 24, I was in a car accident where somebody hit me and totaled me my car. As a result, um, they did a CT scan. They didn't show anything at that time as far as any aneurysms were concerned.
SPEAKER_03All right. So, Carol, I hate to do this to you again, but we got to go to break again. It was a short segment. But we will come back and we will just finish up that last concern that you had when we return. And immediately after that, we will get to David. Stay with us on the weekly checkup, everybody. Welcome back to the weekly checkup. We are presented by Well Star Health System. I'm your host, Dr. Bruce Feinberg. We're live in the studio today with Dr. Amir Ahmad of Heart and Vascular Care. We're talking all things hearts, but we've got to focus, and it's about abnormal heart rhythm. And it includes all kinds of things slow heartbeats, what are called bradycardia, and fast heartbeats, what are called tachycardia, irregular heart rhythms like atrial fib and atrial flutter, which we're going to get into in a minute with David. And the consequences of these abnormal heart rates and rhythms, one of which can be with atrial fibrillation, in particular, strokes. So we just had a call from Carol, and Carol was talking about recovering from a small stroke that the doctors believe was likely caused by an episode of asymptomatic atrial fibrillation. And that's because when the heart beats irregularly, as it does with AFib, the blood doesn't flow smoothly through the heart, and areas can stop their flow, like an eddy in a stream. And that's where the blood can clot. And that clot can then get caught in the stream and be pushed out and go to a place like the brain. And although she was very fortunate and she had no deficit, the docs were concerned and wanted to try to make sure that if they could find atrial fibrillation, either they would have to treat it to cure it, or she might have to be on a blood thinner for the rest of her life and not just baby aspirin. So she wore a monitor for 30 days and was nothing was seen. And now she's calling because they're recommending a similar but an implanted device that will be able to monitor her heart for that irregular AFib for a course of a year. And we had a long conversation about it. And basically they were recommending what is the standard of care. But as we closed the conversation, she brought up this car accident. And she had a pretty significant wreck that totaled her car, and she had a CT scan, which I assume was up her head. And like, well, we had to go to break, and I'm assuming that where the conference was going to go would be, and why didn't they see it then? And couldn't that have explained what happened? You know, why does it have to be all these things? And why do I need this other test? And very common things that go through people's minds. And so I want to address that last question. Then we're going to bring David on and talk about atrial flutter.
SPEAKER_01Yeah. So, Carol, I think, you know, a CT scan is just a snapshot in time. And for better or worse, it may not show any sequelae of atrial fibrillation in terms of blood clots. So I don't know if you can put much stock into the CT scan that you had. You know, I think it could definitely miss something like that. But, you know, if you're still listening and you still have questions, come see me in the office and we can, you know, we can get you all sorted.
SPEAKER_03All right. And with that, let's bring David on. Hey, David.
SPEAKER_07Hey, how are you doing? Thanks for taking my call.
SPEAKER_03It's a pleasure.
SPEAKER_07What do you got for us? So in October, uh I woke up in the middle of the night. I didn't feel right. Um, my wife was out of town, drove myself to the emergency room. Oh, I love it.
SPEAKER_03Isn't it always the case? The wife's out of town, you gotta drive yourself. And I'm sure somebody said, What, you never heard of 911?
SPEAKER_07Yeah, well, I didn't feel that bad. So, but I I just felt weird. Um, got to the hospital and uh had a heart rate of 147. Um, so they did you know AKGs and tests and uh exited me with atrial flutter. Um two days later, I started um excuse me, had a calcium test, um an ultrasound, everything, a monitor for a week. Um, and they put me on a beta blocker, uh, which so far since this is the beginning of last October, so far I've had no reoccurrence or anything, and I'm assuming that's because of the beta blocker. My question is is what is a real flutter? I mean, I've looked it up three dozen times. Um, and how does it uh you know what's what's the long term and or is it something just to monitor and keep up with?
SPEAKER_03Oh, I love it. So it's great. Um, you know, every everybody, we can do the rest of the show. We could have done the two hours on this question. Um, so flutter is less common than atrial fib, and to some degree, they're very much related. Um, origins are in different chambers of the heart, but we're gonna get into all that. Um so let's take that deeper dive. And so before we get exactly into your question, but I guess it was because it's the what is it piece. So for those listening, kind of bear with us, there's has to be a little bit of science, a little bit of anatomy and physiology uh to understand it all. But again, understand that these irregular heart rhythms of the upper chambers of the heart like are gonna, there's more likely that you will have some aspect of it if you live to be like my age of 70 than not. So we're all gonna be experiencing either directly or first degree by, you know, with a loved one.
unknownAll right.
SPEAKER_01Yeah. So David, uh, it sounds like they told you you had atrial flutter. Uh atrial flutter is what I consider a sister rhythm to atrial fibrillation. They're similar, but not the same. Uh atrial flutter tends to be because of a circuit inside of the heart that conducts and then can put you into atrial flutter, while atrial fibrillation is a little bit more of a disorganized beating. Did they talk to you about risks in terms of strokes and these types of things with atrial flutter?
SPEAKER_07Uh a little bit about um, a little bit about a stroke, you know, potential to have a stroke, but uh other than that, nothing else.
SPEAKER_01Yeah, and it doesn't sound like you've ever been told that you have atrial fibrillation or AFib. No. And did they tell you about kind of the different treatment options for atrial flutter? It sounds like they put you on a beta blocker, but did they they talk about anything else?
SPEAKER_07Um, I'm maybe I got this word wrong. Yeah, ablation. You got it right.
SPEAKER_01Yeah, so atrial flutter uh is is pretty common. Uh, you know, that and it's a very curable rhythm. It's one of the few curable rhythms that we can do with what is called an ablation. And so, you know, uh the thought process is that you can treat the rhythm with either a beta blocker, but that's a medicine you have to take forever, right? For something that happened once when your wife was out of town, uh, versus, you know, an ablation procedure, which can be done, which is invasive, but the goal of that is to cure you of that atrial flutter and get rid of that extra circuit that conducts when you are in that rhythm. And so the idea is if you get rid of that circuit, you don't have to be on the medicine, but it also gets rid of that stroke risk that is associated with atrial flutter.
SPEAKER_03So I I want to ask, you know, I'm jumping in here, David. So forgive me, but so the idea of the stroke in AFib is because when the heart's beating so irregularly and the flow of blood is now irregular as well, you get eddies, and those areas are the ones where the blood's can blood can clot. But in flutter, the heart's beating is it's too fast, but it's regular. So why do you get a stroke risk with it?
SPEAKER_01Yeah, so in both AFib and atrial flutter, the top chamber of the heart moves a lot faster than the bottom chamber of the heart. And when you check your pulse or when you wear a smartwatch and it gives you that number that is your pulse, that is how fast your bottom chamber is going. But when your top chamber is going fast, which it does with both AFib and atrial flutter, whether or not it's regular versus irregular has to do with more when it's going very fast, blood does not move efficiently. And when blood does not move efficiently and stays stagnant, it clots. And so that's the case with both atrial flutter and atrial fibrillation.
SPEAKER_03Ah, who would think that I'm still learning? It's an amazing thing. All right. So now, I mean, so is but the the urgency, it seems, is different for flutter in terms of how quickly they have to go into an amoecoagulant.
SPEAKER_01Correct. Yeah. So the risk of stroke is tied to a lot of other things too. So when we think of putting patients on blood thinners for both atrial flutter and AFib, it also has to do with what other things are wrong with you high blood pressure, diabetes, age, and that goes into your stroke risk. And based on those things, we can sort of calculate a risk. And based on that risk, we can talk to you about the pros and cons of a blood thinner.
SPEAKER_03Okay. So I want to get back to the ablation story. And is everybody a candidate? Or, you know, is it because historically it was always drugs first before procedures, because procedures always inherently had greater risk. But it's getting to be your argument is pretty powerful that you want to be on drugs that do have side effects, you know, for decades, or do you want to do a procedure that gets done once and has a high probability of success?
SPEAKER_01Yeah, these days, ablation therapy is very fast, it's very safe. And now we know that most people are actually candidates for an ablation because generally now ablations are much different than what you may have heard of in the past, where it doesn't take several hours to do an ablation. It's an outpatient procedure. You come in, we do the procedure, you go home the same day, put a little bandage on your groin site where we go in with a catheter to do the ablation. Whole thing takes about 45 minutes to an hour.
SPEAKER_03All right. So you mentioned the groin. For a lot of guys, you mentioned the groin, like we're done now. Yeah, like I'll take the pill. Um, certainly in other areas of coronary intervention, percutaneous groin intervention, um they're using the radial artery. Are we moving towards a radial artery which seems to be at a patient much higher acceptance rate?
SPEAKER_01For uh for our ablations, we still tend to use the groin side is it's a straight shot to go from the big vein in your leg all the way up to the heart. And the idea is that the catheters that we use are just easily manipulated from that and give us a really nice, precise accuracy when we're moving it around inside of the heart.
SPEAKER_06All right.
SPEAKER_01David, questions?
SPEAKER_07Uh yeah, I guess the only thing my cardiologist said that the abalation was probably 70% uh effective. Does that sound incorrect?
SPEAKER_01So I would never say that it's incorrect. I think maybe they're looking at older data. So I would say that for atrial flutter, the success rate is about 99%. And so don't like catch a little bit and say 98? No, I'll I'm I'm confident in my skills. Yeah. Uh we we can get rid of your atrial flutter. Now, the success rate for an AFib or atrial fibrillation ablation is about 75% to 80%, depending on how long you've had it for. But for a flutter, ah, close to 100.
SPEAKER_03Now, for flutter and fib, if both are seen, are there two separate procedures? Because it's left and versus right atria?
SPEAKER_01Yeah. So atrial flutter uh is a circuit that extends throughout the entirety of the heart, but part of that circuit lives in the right side of the heart. So if you can cut it there, you can get rid of the entire circuit. For AFib or atrial fibrillation, those circuits that we're trying to destroy sit on the left side of the heart. So the technique uh to get That is a little bit different and requires a little bit of a different approach. And so that is why the success rate is slightly different.
SPEAKER_03Now, the cardiologist you were saying, I'm going to guess, is not a specialist in this in the procedure of the ablation. He's a general cardiologist, correct?
SPEAKER_07Correct.
SPEAKER_03Yeah. All right. I mean, fair. And just because, again, we were talking earlier on the show about, you know, every specialty has gotten so so complex and so specialized that, you know, you're just understand, I'm just gonna make that difference that we're speaking to somebody who does nothing but these procedures. And so he lives this world and it's rapidly evolving, new technology and more experience and more knowledge. So we've got to go to break, break call. Thanks, David. We will be back on the weekly checkup. Remember, get in the queue 404-872-0750 with your question. We'll be back. Welcome back to the weekly checkout. We're presented by Well Star Health System. I'm your host, Dr. Bruce Weinberg. Our show is produced by Lens, Atlanta's Healthcare and Marketing Experts. I'm live in the studio, Dr. Amir Ahmad of Heart and Vascular Care. Join us for the conversation, 404-872-0750. And I gotta say, you guys have been outstanding. You are all on topic. We're talking particularly about heart rhythms and heart rates and related complications. And we've touched on atrial fluttering, atrial fib, and bradycardia, and I want to get back to that. And we got more coming in. So we've got some more calls, but you can get in the queue. Don't miss this opportunity. 404-872-0750. You too can talk to an expert. All right. So I think we've got up first is Cynthia. Let's talk to Cynthia. Hi, Cynthia. Hi, how are you? Good.
SPEAKER_04How are you? Good. So um I went to the emergency room because I felt lightheaded and um my potassium was low. However, uh I was six, I'm 61, so they basically said, Hey, you most likely had a stroke. So they ran all these tests and test after test after test. It was CT scan, the echo, um, they did uh what some just lots of tests, and they found nothing. And um before they released me, they did um after doing that echo, they said they found fluid in my lungs, a very small amount of fluid, and I I wasn't aware, I don't get uh sort of breath or anything. And he said that to follow up with a cardiologist, so I went to a cardiologist, the cardiologist says, well, everybody has a little bit of fluid. Come back in two months, let's run the test again and see how it looks. So I went back in February, they ran the test again, and they said very small amount of fluid, come back in two more months, and we'll run the test again. And I was like, Well, why can't you just compare the tests from the emergency room and the test I just done? And he still wants me to come back two more months. So just weird of does does people is having a small amount of fluid, is that normal or is there issues?
SPEAKER_03Oh, oh, oh, oh. From you know the $25,000 emergency room visit of testing that you had to the communication, it doesn't make medicine look good. But we'll do what we can to try to straighten this out. And unfortunately, um we've got a break coming up, and I don't want to kind of get started with the more complex. So if you can hold. Now we've got Jim, we've got Tom, we're gonna get to all of you because we got a long segment coming up after we go to break. But um, but I I think we can try to make sense of all of this. But I do, and uh, but we're gonna need also some more help, and we're gonna need to know a little bit more about your medical history. So think about that. If you're on any medicines, things like low potassium normally just don't happen. So we want to know a little bit about that. You know, were you on a medicine for some reason? Like it could be a diuretic because of high blood pressure or something else, but those things would all be a factor in kind of getting to the bottom line of your story. And with that, we're gonna take a break, but we will be back on the weekly checkup. Remember, we've got room in the queue, 404-872-0750 is how you reach us. Something to do with health care and heart, and make it in the form of a question, and you might get your questions answered on the show. I'm with Dr. Amir Ahmad of Heart and Vascular Care, and we will see you in the field. This is a weekly checkup, and we are sponsored by Well Star, and we are presented by All Care, offering preventive health and immediate access for your urgent medical needs, the Georgia Trauma Foundation, investing in trauma care to save lives. Alanski Dermatology and Aesthetics, offering the highest quality in medical, surgical, and cosmetic dermatology, Avant gynecology, Atlanta's GYN and Surgical Specialist, and virtual imaging, EBT screening for cancer and cardiovascular disease. We are back live in the studio. I've got Dr. Ahmad Amir, and we are talking about vascular health and heart health. And in particular, uh, we've been having these great conversations about all the things related to heart rate and heart rhythm, disturbances of which produce symptoms, but also can lead to complications, how they can be managed. And again, you guys are the callers have been great. And we are going to finish up with our caller Cynthia, who had gone to the ER after feeling lightheaded, had the huge workup, you know, the $10,000 plus workup, thinking there might be a stroke. And the only thing they found, which they couldn't quite explain, was a little bit of fluid in the base of the lung. And she was referred to cardiology, she's been seen by cardiology, and she's now being seen every two months for this minimal amount of fluid in the base of the lung without a really good understanding about what is this the reason for this surveillance and what is the implication of this fluid. And so we've got our expert here and uh Amir, take it away and help us understand what we're seeing.
SPEAKER_01Yeah. So Cynthia, um, uh it sounds like the testing that they've done so far has all been normal. Is that what they've told you?
SPEAKER_04Yes, that's correct.
SPEAKER_01Okay. And are you on any medications currently or no?
SPEAKER_04No, uh, no, I'm not on any medication. I've never been on medication. I'm 61 years old. Sometimes my blood pressure does be is like 130, uh maybe like 82 over when 130 over 82, something like that. It depends if I eat it for something like that. However, the reason for the low potassium is I went to the doctor uh maybe uh two years ago, and he said that my A1, I'm I'm pre I'm pre-diabetic. And he said I needed to change my eating habits because I'm really one of those people who don't believe in like the medication thing. So I changed everything. Like I ate a lot of, I ate healthy, but I ate a lot of carbs. So he was like, okay, um, you have to cut out even the bananas and all the stuff that I'm eating. It's a lot of carbs, sugar. So I cut, I basically changed the eating habit, cut anything out that was white. Yeah. So every so I lost probably 12 pounds after that. And my my I think that's the reason the potassium went low.
SPEAKER_01I I'm not sure, but I Cynthia, I think it's it's tough. Yeah, you know, I think, yeah, sometimes people can have a little bit of fluid at the base of the lungs. I don't know if there's any real benefit to surveilling it every few months just to see if it's the same or or or not, especially if you're not feeling any different. I think what I would say is I would look out for symptoms. So if you start to feel more short of breath, you're not able to do the things that you're able to do, like go from the kitchen to the bathroom without getting winded, you feel like your symptoms are getting worse. And I think it makes sense to see if things have changed. Um, but in the short term, I you know, I think repeating the imaging over and over again when nothing has really changed with you probably isn't going to change what they end up doing for you.
SPEAKER_04Okay. So why would I have fluid? Why would I have influid there?
SPEAKER_03So the one the doctors did say there is a look that normal, normal is normal to have a little bit of fluid. And fluid is much more evident on a CT scan than it would be on a plain chest x-ray. So if they did a CAT scan of your chest, they might have seen it where they wouldn't have seen it on a plain chest x-ray. But they did an echo and And they said that was okay.
SPEAKER_04Well, they did the echo, I think, I think it was called Echo where they went in and they watched, they put this um Yeah, they put a probe over the chest and they look at the heartbeat.
SPEAKER_03Yes. And that and that's done to look at heart function to make sure you're not in any kind of heart failure. And if the heart's not pumping adequately, because the blood pools, liquid can leave the blood space and it could accumulate in the base of the lung. But it appears that that's not the case, and the cardiologist is not telling you, and then they're not recommending any medical treatment. So at some point, it's like, fine, you know, if I checked me a two-month and nothing was there, at least make it four months. Like do something different, something to like demonstrate where is this going to go. And that's where I was finding it. You know, I think if you had gone to see primary care, they probably would have said the same thing, you know, you just heard. It's like, if, you know, I wouldn't worry about it if you get symptomatic. That would be kind of a, I think, a very practical response. I think if if there's a concern about wanting to do surveillance, at some point it's gotta, you gotta extend it. You go two, no problem. You go four, and at some point, you know, it's stable. Whatever it is, it's stable and it's not affecting you. So, you know, nothing to worry about. Okay. All right. Well, thank you. You take care. All right, thanks. You're welcome. All right, and with that, we've got time holding.
SPEAKER_06Yes, hello.
SPEAKER_03Hey Tom, how are you?
SPEAKER_06All right, how are you?
SPEAKER_03Excellent, thanks.
SPEAKER_06Um, I got diagnosed with AV about two years ago, so I had four quick questions I wanted to ask your doctor. Um, currently I'm on a blood thinner called a Pixaban or Eloquist, and I wanted to know if your doctor thinks there's a certain blood thinner that's more safer or effective than the others. All right, that's all there. That's the one at a time.
SPEAKER_01Yeah. Right. So, uh, in terms of the blood thinners available on the market, the data that we have and and some head-to-head comparisons does show that Eloquist among them is probably the safest in terms of bleeding risk, meaning, you know, keeping you from bleeding, and then also efficacy, meaning preventing those blood clots from forming.
SPEAKER_03Okay, and as we said in Run Python, you chose wisely. All right.
SPEAKER_06Uh the second question. Um, when I first got diagnosed, they did a shock procedure. I think they called it a cardio inversion procedure. That's where they shock your heart, similar to the way a paramedic shocks you. And it's supposed to restore your heart rate to normal, but it didn't work. So I was wondering if you could have that procedure done over and over, or do you just normally do it one time?
SPEAKER_01Yeah, I wouldn't recommend it having it done over and over again, you know. Uh, but a cardioversion or a shock procedure can be very effective up front to keeping you in a normal rhythm. Uh, but generally speaking, it's about 50-50 at six months, whether it keeps you out of AFib or not. And so what I think of it as, I think of it as a band-aid. It's a temporary fix to a long-term problem, and it shouldn't really be the only thing that you have done.
SPEAKER_06Okay, and then the third question, uh I've heard about a surgical procedure where they implant a filter device in your heart, which is supposed to filter out blood clots. I wanted to know your opinion about that procedure.
SPEAKER_01Yeah, so the filter that you're referring to refers to a device that we can put in a particular area of the heart where blood clots can form because of AFib. Now, 100% of the blood clots don't form in that area, only about 90 to 95% of blood clots form there. So if you put a blood clot, if you put a sieve or a filter there, you still have the ability to get blood clots elsewhere. And so what you're talking about is a device, one of the brands, commonly known as a watchman, is a procedure that we can do to hopefully get you off of blood thinners. But what we know is that blood thinners are still the best. It's a pill that you take that works on your entire body, right? Uh a procedure can put a plug in a specific area, but you're still left with areas that you can form blood clots. So what I tell patients is that if you can be on a blood thinner, like a Pixaban, it's the best option. But if you can't, and the option is nothing, then a watchman or these types of devices that plug that area is better than nothing.
SPEAKER_03So some people, because of bleeding, other bleeding issues they have, they may have bleeding issues in the stomach or other place in their body, and a blood thinner is just too risky because they could bleed to death on a blood thinner. And so that device is great to have an option that didn't exist previously for people like that. So I just want to understand that there are people you're not having those problems, but there are people who do. All right, your fourth question, fourth and final. Time go.
SPEAKER_06Oh, okay. Before I got AFIB, I used to exercise at a high intensity level. I used to do a lot of jogging. So I'd like to know if AFIA patients should avoid heavy exercising, or should you keep your heart rate within a certain level or intensity, or are there any signs to look out for if you overdo it?
SPEAKER_01Yeah, so I think you should always try to continue to get a healthy amount of exercise. And so what I tell patients is that you want to do things that make you feel like you've actually worked out, right? So you want to feel shorter breath, you want to feel like you put in a good effort, and you shouldn't avoid those even though that you have AFib. The things to look out for if your heart rate gets significantly elevated, usually I say above 160, 170 for more than about three to four hours after you're done working out, that can be a problem. But you shouldn't restrict yourself if you're feeling good during your workout.
SPEAKER_03Yeah, I might just want to add is the nature of the exercise because the blood thinner has an implication as well. And, you know, so people occasionally, you know, fall when they run. And a fall can be nasty when you're on a blood thinner. Whereas if you were on a stationary bicycle, a rowing machine, maybe even swimming, you wouldn't have those risks. So that may be another thing. I don't know if you feel that way and if you ever advise.
SPEAKER_01Yeah, I think yeah, I think if your exercise of choice is rock climbing without a harness and you're on a blood thinner, I'd probably stay away from that. But if you like jogging on the treadmill, you like the stationary bike, swimming, I think those are great forms of exercise that you would continue to do even with AFib and uh on a blood thinner.
SPEAKER_06Tom, thanks. Okay, that was great. Appreciate the info. Yeah. Oh my neighbors said to tell you they appreciate your show. Uh we're all seniors out here in my neighborhood. Well, love to hear that. Tell them all I said thank you for listening. Okay, they said to tell you you need to come start coming to work more often. Oh my god, you live you live near Ray?
SPEAKER_03Is Ray one of the neighbors? Pardon? Is Ray one of your neighbors?
SPEAKER_06No, I've heard him calling it.
unknownYeah.
SPEAKER_03All right, come on, people. Yeah, okay. All right, thanks. All right, you take care. Thanks again. All right, all right, so we've got another call coming in. Um we don't have enough time for this call. Maybe we can get to the caller on the last segment because we are coming back after the next break, but we could in maybe a minute. Um, because we had a call about um episodic uh heartbeats. So I'm thinking APCs and VPCs, a quick uh comment on a minute about these extra heartbeats.
SPEAKER_01Yeah, so uh APCs or VPCs, what do these refer to are extra beats that can come from the top or bottom chamber of your heart. And so when that happens, you can have symptoms like palpitations, skip beats, fluttering in the chest. Generally speaking, it is safe and it's not dangerous. When you have a high burden of extra beats, either from the top chamber or the bottom chamber of the heart, they can either lead to more arrhythmias like AFib if they're coming from the top chamber, or they can weaken the pump function of your heart because it makes your heart beat inefficiently. And so generally speaking, if you're seeing a lot of extra beats either on your wearable, like a smartwatch, or you feel it, you should see your doctor to kind of quantify how many of your beats are extra beats, because that can definitely impact what we end up doing for it. And they're usually medically managed? Most of the time we medically manage, but if you have a high enough percentage, that is also something that we can address with what is called an ablation procedure.
SPEAKER_03All right, fabulous. You did it right on time. All right, we've got Juanita Holing about devices to help clotting. We will get to that question when we come back after the break. And that, folks, will be our last question of the day. Stay with us on the weekly checkup. We are wrapping up another edition of the weekly checkup. We're presented by Wellstar Health System. I am grateful to Dr. Amir Ahmad of Heart and Vascular Care to be live in the studio to take all your calls. We're gonna try to squeeze in one more call. So we're gonna talk to Juanita, but we'll have a short amount of time. So Juanita, 30 seconds or less. What's your question?
SPEAKER_02I want to know if any of those devices get stopped up with the clots. That's a great question. I know that with stance it does. And then when they have the stopped up uh screen, I guess you could call it, then they have to go in and remove it and put another one in.
SPEAKER_03All right. I love it. We're gonna try to give you we're gonna try to give you a 30-second question, a one-minute response.
SPEAKER_01Yeah, so uh generally speaking, no. Yeah, so the the devices that we're putting in, either a watchman to prevent clots or pacemakers and these things are are not really prone to getting blood clots on them. And that has more to do with where they're located and the blood flow surrounding those devices. So generally speaking, those are that's really not a concern that we we really worry about.
SPEAKER_03Yeah, and a lot of it is you know uh advanced materials. Because in the early days, anything put into the bloodstream, you know, is prone to generate a clot. And but new advances in materials um have really changed that as well. So that's good news. If that was a concern that's been limiting you from making a decision, it's you know, you've got that now. All right. So I need to thank you. We're gonna kind of close it up. It's because it's been uh a fun, fun two hours. Uh, Amir, kind of a closing comment from you as our guest today.
SPEAKER_01Yeah, so thank you again for having me. It's been great. Um, so just to let everyone know, so uh Heart and Vascular uh offers kind of full service cardiology ranging from general cardiology, preventative cardiology, uh ranging in specific to women's cardiology and women's health as well. And then what I do, which is electrophysiology. So we have offices in Alpharetta, Cumming, Canton, uh uh throughout. So if you're interested in seeing us, uh you can follow us at hbcmd.com. You can see where our offices are. Generally speaking, for myself, uh, you can probably see me in the office in two to four weeks, no problem, uh, and we get taken care of. Uh and then Heart and Vascular also has an immediate care clinic. So uh, you know, if you're coming out of the emergency room for things like chest pain, atrial fibrillation, we can see you within 48 hours as well. Uh, and then not to compete with you, Bruce, but Heart and Vascular does have a podcast themselves, uh H E C M D, uh, where we kind of go through common topics like atrial fibrillation, watchmen devices, ablations, where patients can kind of learn and see, uh, you know, hopefully get their questions answered before making a decision on any of these things.
SPEAKER_03All right. So when you need to take a break from listening to the weekly checkup podcast, you now have another healthcare podcast you can listen to. Uh thank you. All right. Um, you go to more than one location, correct?
SPEAKER_01Correct. So I see patients uh in the Canton area, Cartersville, uh, and the Cumming location uh as well. But we also have another electrophysiologist who sees patients uh closer to Johns Creek area, Alpharetta, uh, and Cumming as well.
SPEAKER_03All right, so you've got that north, central, and northwest, you know, pretty well covered. Nice. Well, I I thought it was great. I I I don't they were you know, I even had a factoy today, you know, so it's always great when I pick up something I didn't know. But I um the diversity of our calls today just really made the show. Um, you know, from you know, slow heart rhythms and fast heart rhythms to AFib and A-Flutter to extra beats. I mean, we covered a huge gamut and we got to touch on strokes and other conditions that are related. And um, I I love when we have that opportunity to really get to inform our audience and do it in a way that hopefully is gonna you know help you with your healthcare. So, time to bid you farewell. I'm Dr. Bruce Weinberg. This has been the weekly checkup.
SPEAKER_00Thanks for listening. Tune in next time for another cardiology focused episode.