The Health Curve

Arrhythmia: When The Beat Is Off - with Dr. Jaspal Gill, Cardiologist and Clinical Research Fellow at the University of London (Heart Health Series)

• Dr. Jason Arora • Season 1 • Episode 15

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Your heart is designed to keep a perfect rhythm—but what happens when that rhythm falters? In this episode, we look at arrhythmias, including atrial fibrillation (AFib), which now affects millions and significantly increases stroke risk. 

We explain how to recognize palpitations, dizziness, and other signs that something’s off—and what treatments and technologies are available to help get your rhythm back on track. 

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In this special 4-part series on heart diseases, we're going to give you something that's getting harder and harder to come by: time with a cardiologist. 

Access to medical care is a growing challenge—especially when it comes to specialists. In the U.S. today, a single cardiologist may be responsible for thousands of patients, and nearly half of all U.S. counties don’t even have one. 

We’re joined by Dr. Jaspal Gill, Cardiologist and Clinical Research Fellow at the University of London, to break down the fundamentals of the most common—and most critical—heart conditions: high blood pressure, heart attacks, stroke, and arrhythmia.

SPEAKER_00:

Hello and welcome to The Health Curve. I'm your host, Jason Aurora. In this special four-part series on cardiovascular health, we're going to give you something that's getting harder and harder to come by. Time with a cardiologist. This episode is on rhythm disturbances, also known as arrhythmias. Arrhythmias are surprisingly common, estimated to impact up to 1 in 20 adults. They can range from harmless to life-threatening, but in general, we know that they often increase the risk of more dangerous medical conditions such as stroke, heart attacks, and blood clots. In our fourth episode with Dr. Jaspal Gill, we're going to explore this in more detail. Okay, let's move on to the last topic of this episode, which is arrhythmia or rhythm disturbance for the heart. Can you tell us what that is and what's happening in the body?

SPEAKER_01:

Yeah, so rhythm disturbances are usually grouped into two different types. And that's rhythms of the heart, which are going too fast, or rhythms of the heart that are going too slow. Now, when we're talking about the rhythm of the heart, the heart has got an intrinsic way that it beats. And you see this in kind of cartoons or in movies that, you know, someone's heart's come out, it still beats when it's outside the body. And the heart does do that. It's got that intrinsic beat to it. But it's also being controlled from different mechanisms within the body and within the heart itself to tell it how fast to be. And if there are any problems with that control mechanism or the inputs that feed into it, then that can either cause the heart to go very fast, which can cause dangerous fast heart rhythms, but it can also cause the heart to become very slow and you can have dangerously slow heart rhythms. And obviously very fast heart rhythms, if it's pumping so fast, that it can't actually do the pumping job properly because there's not enough time for it to fill with blood. And that means that actually it's not able to pump any blood either. So in the same way that your other organs around the body won't be able to receive their blood, that can cause something like a cardiac arrest, which is what we mentioned earlier. Additionally, if their heart rhythms are going very slow, that can also cause a cardiac arrest. If the heart's just not pumping quick enough to be able to supply blood around the body, that can all cause problems for people. And they can also give a huge wide range of symptoms. And that can be at one end, palpitations and things like that, which is feeling your heart race or being aware of the heartbeat. And that doesn't necessarily actually need to be fast, most often described in the context of fast heart rhythms. But it can sometimes be slow or even at normal heart rate. But it can also be things like feeling dizzy or people who are experiencing things like faints. Sometimes shortness of breath also can be explained by abnormal heart rhythm. So it's actually a very broad topic that can have a variety of different symptoms depending on what the exact nature of each individual problem is.

SPEAKER_00:

What exactly is happening to the heart? Why is it having a rhythm disturbance and what are the implications of that for the body?

SPEAKER_01:

So there are many different reasons. depending on exactly what the type of rhythm disturbance is. We've mentioned some of them already. So for example, people who've had a heart attack, when the heart's undergone that kind of insult, it's all a bit irritable. It's much more likely to go into abnormal heart rhythms. In terms of slow heart rhythms, they're much more likely to happen when people are older. And that's simply because of the aging of the conducting system within the heart is less likely to work as well. And that can cause people to go into slow heart rhythms, which can be dangerous and life-threatening. And that's where we recommend things like pacemakers to try and help people. In terms of the fast heart rhythms, there are so many different reasons why people can have these. Sometimes it's genetic. Sometimes people are born with something that makes them more likely to have abnormal fast heart rhythms. The most common abnormal heart rhythm is something called atrial fibrillation, which is actually completely multifactorial. And some of the things that we've already discussed to feed into it, for example, things like having high blood pressure, things like diabetes, having any problems with your heart. These all increase the risk of having atrial fibrillation. And actually the problem with atrial fibrillation is not actually the heart rhythm itself, but actually one of the problems that it causes, which is that it can increase the risk of clots forming within the blood. And that people often don't have any symptoms related to atrial fibrillation or any problems with it at all, except for this increased risk of clots forming. And if clots form within the heart itself, Those clots can sometimes break off. If they break off, they can then go and travel into the blood vessels and cause blockages within those blood vessels. And guess what? If that blockage happens within your brain, that's a stroke. And so that's why actual atrial fibrillation, one of the most important aspects of that as a fast heart rhythm, is actually stroke prevention. That's one of the most common reasons that people are on blood thinning medication.

SPEAKER_00:

Why does the blood clot if there is an abnormal rhythm in the heart?

SPEAKER_01:

So in the normal heart, when there's normal pumping that's going on, it's usually a very smooth process. So blood comes in, it'll sit there for a fraction of a second, and then it gets pumped and it goes straight out. If, for example, you're in atrial fibrillation, that kind of smooth pumping function doesn't happen. And that means that the blood there isn't just sitting there for a little bit longer. It means it's not just there for that kind of split second that it would have been otherwise. It's sitting there for a couple of seconds. or even longer than that sometimes. Sometimes it can be there for 10 seconds, 30 seconds, minutes even, without moving a huge amount because the heart around it is just doing a little bit of a dance but not actually pumping it well. And in that case, the blood is made to move. And if it doesn't move, it stops the clock. And that's exactly what we see in that circumstance, that it's more likely for a clock to

SPEAKER_00:

move. What are the implications of an abnormal heart rhythm or arrhythmia? Why is it a problem?

SPEAKER_01:

So I suppose it depends a lot on what the symptoms of the patient is experiencing. There are some heart rhythm problems that are not a problem if the patient's not having any symptoms relating to it. There are some heart rhythm problems that are a big problem even if the patient is not having symptoms relating to it. So a lot of it depends on the nature of the exact heart rhythm problem. One thing that I will say is that, for example, in people who have abnormally slow heart rhythms, Those are patients who we'd recommend that we implant something called a pacemaker. Now, a pacemaker is a small device that sits underneath the skin, usually just underneath the collarbone on the left-hand side with up to three wires that go down into the heart. And they're sensing what the heart is doing. And if they sense that the heart is going too slow, the pacemaker can kick in and give that electrical stimulus to try and tell the heart, hey, you need to get going again. And that will increase that heart rate back up. And that's absolutely fantastic. But it only treats slow heart rhythms. It doesn't deal with all the fast heart rhythms. But even better than that, we've got something called a defibrillator. And that's an improvement of a pacemaker. It's a type of pacemaker where it can actually recognize if the heart's going into fast heart rhythms as well. And the way that it tries and treats people with that is that it can try and then deliver a shock to try and get people out of any abnormal or dangerous fast heart rhythms as well. So people with defibrillators, they have a device that can deal with both slow rhythms and fast heart rhythms.

SPEAKER_00:

Right, and that gives the heart a shock, which basically resets the electrical rhythm of the heart, right?

SPEAKER_01:

That's exactly right, yeah. So it can reset it, and it gives the heart the chance to just go back into its normal heart rhythm and get back into what it's normally doing.

SPEAKER_00:

We'll get back to this conversation in just a moment. But if you're finding this episode helpful... Here's a quick ask. Take a second to follow or subscribe to the Health Curve podcast wherever you're listening. And if someone in your life would benefit from this episode or any of the others you've heard, please send it their way. All right, let's get back to it. And how is an abnormal heart rhythm diagnosed and then treated? So

SPEAKER_01:

the typical way that we diagnose any abnormal heart rhythm is by a KG. We also use something called a Holter monitor or a 24-hour heart monitor, which is just like an EKG, but you have it on for 24 hours, sometimes as long as 48 hours or seven days. And there have been modern improvements of that, things called patch monitors, which you just stick straight onto the chest, which do exactly the same thing. And they're monitoring the electrical activity within the heart so that we can try and diagnose what's happening. Now, unfortunately, most of them don't give us real-time data. They just collect the data. You have to hand it in, and then it gets analyzed, and then we identify if there are any abnormal heart rhythm problems on. But even modern gadgets, modern wearables, things like an Apple Watch or a smart watch or cardio devices, which are openly and easily available, we often end up finding more and more these days that we're using these to diagnose our heart rhythm problems. So patients will have palpitations. And obviously they don't happen to have an EKG machine with them or to have a heart monitor on, but they'll have their Apple Watch on. So they take an ECG with their Apple Watch and they send it to us and they say, what do you make of this? And actually that's a reasonably valid tool as well to be able to detect these heart rhythm

SPEAKER_00:

problems. So if a heart rhythm disturbance is diagnosed, how is it treated? So

SPEAKER_01:

I think that's quite a broad question because it depends very much on what the nature of the heart rhythm problem is. We touched a little bit on what we do about slow heart rhythms in terms of using a pacemaker to try and increase the heart rate. Unfortunately, for slow heart rhythms, there are no medications that we can really use to try to treat it. The only option is a pacemaker, essentially. For fast heart rhythms, we've got lots of different options. We can either use medications to treat people. Some people can be treated if they have defibrillators implanted. And also, we've got procedures that we can use to try and help people. We can do things called ablations. where we try and map out any extra circuits that there are in the heart, map where this abnormal heart rhythm is coming from, and then try and get rid of that extra circuit, get rid of that extra limb to try and prevent that from happening, to try and prevent people's heart from going into that abnormal heart

SPEAKER_00:

rhythm. When someone has an abnormal heart rhythm, particularly if it's a fast one, and it's been treated with a medication and or a pacemaker, What's the long-term plan after that? Is it that the patient has to be on that medication for life or use the pacemaker for life? Does the heart rhythm ever change back to normal?

SPEAKER_01:

Yeah. So, I mean, there are lots of different eventualities and every patient's experience will be individual. For a lot of different fast heart rhythms, it's usually quite unlikely that people go into a fast heart rhythm and just stay in it. They're often clicking in and out of it. And by Using different medications, different treatment methods, we just try and make it more likely that they're going to stay in normal heart pumping rhythm, which is called sinus rhythm. In some cases, if people have their procedures done, we can have really high success rates. We can actually achieve a cure in a good number of different fast heart rhythm conditions, which is absolutely fantastic. In some people, it can be a little bit more tricky. But in general, if people are on medication for the fast heart rhythm, we actually usually have to just keep an eye on them. They're often going to be under follow-up for a while with their cardiologist. And depending on how their symptoms are, depending on how much time they are spending in these abnormal heart rhythms, their medications might need to change. They might need to have additional medications. Sometimes they can come off their medications if it becomes something that's not bothering them or if actually they're hard spending most of the time in normal medications. Actually, there's an entire different myriad of different possibilities when it comes to all these different heart problems.

SPEAKER_00:

Let's get into some of the common myths and misconceptions about arrhythmia. One is that people think if they drink too much caffeine, they can cause themselves an arrhythmia. Is that true?

SPEAKER_01:

That's 100% true. That one is not a myth at all. That definitely plays into different rhythm problems that people can have. Caffeine can trigger different rhythm problems for people as well. So that one's definitely not a myth, 100%. That is something that's important. And sometimes we find that people's symptoms can actually almost entirely be controlled by just reducing their caffeine or by switching to decaf.

SPEAKER_00:

If someone has arrhythmia, are they able to exercise? In general,

SPEAKER_01:

yes. There are a few very specific types of arrhythmia where we recommend trying to avoid heavy exercise. But in general, most people who have an arrhythmia problem can exercise. And in a good number of cases, it will actually help. I would always recommend discussing a specific situation with your physician to seek advice.

SPEAKER_00:

Can I only have an arrhythmia if I'm old enough?

SPEAKER_01:

No. In fact, actually, arrhythmia problems are something that actually can affect people from a very young age, especially certain types of rhythm problems. We see them more commonly in people younger in age and even in the kind of children in pediatric age groups as well. So rhythm problems are definitely something that can affect people of all ages. But as with many things in healthcare, they do become more common as one gets older.

SPEAKER_00:

And this can happen in both men and women, right?

SPEAKER_01:

That's correct. There are some slight different sex prevalences with the different rhythm problems, but all rhythm problems can occur in both men and women. So a common misconception that people have is that if they've got a pacemaker in, that that just takes over the pumping function of the heart and it just can do what the heart does and unfortunately that's not the case i wish that was the case if it was we'd be doing great jobs as cardiologists but unfortunately a pacemaker only deals with the electrics of the heart so it can deal with that slow heart rhythm if it's a defibrillating pacemaker it can also deal with the fast heart rhythms but for example if that heart's pumping function is still not great The pacemaker is not going to be what can completely save that person. There are certain types of pacemakers that can help the pumping function a little bit. But if, for example, someone is having a cardiac arrest for a different reason, if they're having a heart attack and they've got that blocked vessel and the heart isn't able to pump, that pacemaker is not going to be able to solve that problem for them. That's something that people often get mixed up. They think that their heart's invincible if they've got a pacemaker in. I wish that was the case, but we're not there yet. maybe in another 10, 15 years.

SPEAKER_00:

Yeah, it's not an artificial heart, right? It's a device that helps with one aspect of what the heart does. What's an echocardiogram?

SPEAKER_01:

So an echocardiogram is a very, very common test that the cardiologists use. And it's essentially using an ultrasound beam to try and examine the heart. That means it's exactly the same type of scan that a pregnant lady would have when they're looking at the baby. But we're using it to be able to look at the heart. The main things that we're looking at are the heart's pumping function, We're looking at the valves to see if the valves are either narrowed or if they're leaky at all. And we're looking to make sure that all the parts of the heart are pumping the way they should and that everything is linked up and attached the way and plumbed in the way it

SPEAKER_00:

should be. Dr. Jaspal Gill, thank you so much for joining us for this four-part series. We're very grateful for your time. I know many patients wish they had more time with a cardiologist, so it's been an absolute pleasure. And I'm sure our listeners and their loved ones will get a lot of value out of it. So thank you.

SPEAKER_01:

It was a pleasure to be here, Jason. Thank you so much for inviting me.