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Welcome to Doctor Warrick's Podcast Channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, I’m Dr. Warrick Bishop and welcome to my consulting room. Today I'd like to talk a little bit more about atrial fibrillation and one of the things that people often ask is "who gets it?." Well, men and women get it. Men - probably slightly more if you look at the numbers. Women interestingly when they suffer the condition run a higher risk of complication. So although there are more men in numbers actually suffer with atrial fibrillation, women have a higher rate of complication and therefore are impacted equally. This is particularly the case as people get older because one of the things that we see with atrial fibrillation is an increasing incidence of the condition as people age. We do see a genetic predisposition and there are certain families where a genetic link can have a significant up regulation of the likelihood of someone within their family developing that condition. This is not the most common situation but it certainly is important to be aware of. When we think about the things that are likely to increase the likelihood of atrial fibrillation, then we can think of “aetiologies” or causes that impact the structure and function of the atrium, the top chamber f the heart. Simple things like high blood pressure where the back pressure has a stretching effect on the atrium, over time will change the shape of the atrium and by changing the shape of the atrium, increase the likelihood of developing an abnormal rhythm within. The change of shape is often associated with scarring - microscopic scarring nonetheless but scarring that affects the way that electricity flows through the atrium and again starts to push that risk of developing atrial fibrillation up. So age, with a little bit of micro scarring, general wear and tear with time, high blood pressure leading to pressures affecting the atrium. The valves being abnormal can also have an effect on the pressures within the heart and so abnormality of the valves and how they work can lead to back pressures that again impact on the atrium and therefore the structure and subsequently the function. Of course things like cardiac failure or abnormality if the muscle of the heart can also be implicated and associated with an increased likelihood of developing atrial fibrillation. We can also think of things that cause atrial fibrillation in the context of external factors or things outside the heart that impact the heart. It turns out things like diabetes over the long term seem to impact the heart possibly with byproducts of diabetic metabolism ending up within the structure and the fibres of the myocardium, therefore impacting how the atria and the muscles work. We see that obesity is linked with an increased likelihood of atrial fibrillation and obesity together with obstructive sleep apnea a condition where people obstruct their respiratory system at night while they're asleep and really suffer with low levels of oxygen overnight. These situations trigger a very brisk response of the autonomic nervous system so the body is heightened although the person is asleep and can increase blood pressure and it can drive scarring and inflammation within the heart. Again all contributing to the possibility of developing atrial fibrillation. We see that people with bad kidney function over a period of time have a high propensity to develop atrial fibrillation - nearly 20 percent of people with chronic renal disease  will develop the condition and this is a complication of multiple things: elevated blood pressure, inflammation, general propensity to scarring and change within the heart. We also know that external toxins - and probably the most common is alcohol - can raise the likelihood of development of actual fibrillation. So, a boozy night out with a lot of snoring and bad sleep is exactly the sort of thing that could trigger off enough electrical activity within the heart to kick off an episode of atrial fibrillation. In fact we do see it not uncommonly that people will turn up on a Monday morning with a Saturday night arrythmia from exactly that. We see other stresses on the heart also have an effect in the likelihood of atrial fibrillation being present or being precipitated by such things as surgery; whether it be bowel surgery but of course very commonly, any surgery on the heart where the atrium are actually manhandled and touched during the process markedly increase the risk of development of atrial fibrillation, as you'd expect. Infections can do it as being a trigger as severe infection of any sort. In actual fact because the body is responding in such a way that extra adrenaline, extra nervous activity is all being generated and that can increase the likelihood of abnormal rhythm within the heart - particularly atrial fibrillation. We know that other conditions such as pancreatitis, for example, could also lead to atrial fibrillation. So anything within the body that can really increase what we call the autonomic nervous system - which is the fight or flight nervous system - can kick off an episode of atrial fibrillation. Lastly and really importantly emotional stress can do it as well and it is not uncommon for me to see patients who for various reasons had a significant emotional impact - whatever that might be - and they literally felt that in their heart with their heart jumping and fluttering. And that emotional stressor it being the precipitant for actual fibrillation to kick off in that individual. So what can we do. Well, age we cannot avoid. It will lower our threshold of development of atrial fibrillation no matter what. So age is one that we can do little about. But things like blood pressure, weight control, good sleep, not too much alcohol, not too much emotional stress and being aware of where actual fibrillation can occur is a really important first step. One of the areas where atrial fibrillation occurs - which is really surprising so I've left it to the end - is that we can sometimes see it in endurance athletes, so we know that exercise in general is very good for our health, no question about that. Normal levels of exercise, moderate on a weekly basis or several times a week will lower our risk of coronary artery disease, lower our risk of heart related illness, and in fact lower our risk of atrial fibrillation. However in a specific subset of athletes who train for endurance events or long protracted training sessions and long events these people have been shown for multiple reasons to run a higher risk of atrial fibrillation in the longer term. And this is possibly related to that endurance activity leading to significant stress on the heart with return of blood that acts as its own impact on the chambers of the heart leading to dilation and compensation of the heart. That long term exercise seems, together with a change in the neurological way that the heart responds with a tendency towards the Parasympathetic nervous system (slows the body down) which is the opposite of the Sympathetic Nervous System (speeds the body up), seems to lower the threshold for development of atrial fibrillation, and so quite surprisingly, the last group who may get atrial fibrillation is the group of people who are actually very well trained athletes. So be aware of atrial fibrillation and who gets it, I hope that all make sense. Thank you very much for your time. You have been listening to another podcast from Dr. Warrick. Visit his website at. www.drwarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.

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