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Week: 514.4 Guest: Dr. Louis Grenzer, Cardiologist Dir. Behavioral Medicine, Duke University Topic: Heart Fibrillation Producer/Host: Steve Girard

ROEDER: This is a conversation on heart fibrillation with Cardiologist Dr. Louis Grenzer from Baltimore, Maryland.

ROEDER: Dr. Grenzer, a term that comes up in the medical literature and people hear it from their doctors sometimes when they have a condition known as a fibrillation. Would you explain what fibrillation is and how serious it is.

GRENZER: Fibrillation means that instead of beating in an organized fashion, the heart muscle quivers. It just quivers continuously and it's not able to then pump the blood forward at all so in talking about fibrillation, we have to define whether we're talking about atrial fibrillation or ventricular fibrillation. The ventricle is the thick large part of the heart muscle that pumps the blood out to the rest of the body. The atrium is the thinner less muscular part of the heart that pumps the blood into the ventricle so you can do pretty well if your atrium is fibrillating. That, by the way, is what President Bush had when he developed a thyroid condition. It led to him having atrial fibrillation. When you have atrial fibrillation, it ordinarily causes the heart to beat rapidly so that the main thing we have to do if someone has atrial fibrillation is slow the heart down by giving certain drugs. You can tolerate atrial fibrillation pretty well and in many cases, once we start drugs, it will go back to normal beating and if it doesn't, one of the risks of having atrial fibrillation is that clots can form in that quivering part of the heart and when these clots break off and go to your brain or your kidneys, they cause strokes or problems with your kidneys and so forth so that a patient with atrial fibrillation which doesn't go back to normal may end up on blood thinning medicine, anticoagulants. Now ventricular fibrillation is a whole different story. If your ventricle starts fibrillating, you immediately would pass out and unless the condition is corrected because the heart is not able to pump at all, then the patient would die. So ventricular fibrillation, which for instance frequently occurs at the time of an acute heart attack, results in the immediate development of unconsciousness if it's not treated with a device which just shocks the heart which is called a defibrillator the patient would not survive the attack, however, if the patient happens to be in the hospital or if the patient happens to be in an area where medical attention is fairly quickly available, that shock will convert the rhythm back to normal and the patient will be right back where he started so ventricular fibrillation is obviously a very dangerous and life threatening condition which needs immediate treatment and sometimes results in a patient getting a defibrillator implanted into the heart and under the skin to prevent it from recurring again. So when you talk about fibrillation, you really have to divide it into those two categories. The one type is much more serious. Both types can cause problems.

ROEDER: And in the case of atrial fibrillation, is it ever possible that it's minor enough that initially a person might not even notice they're having it?

GRENZER: If the heart starts beating rapidly, even a really healthy person will notice palpitations.

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