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Having Surgery? Post-Operative A-Fib & Protocols to Prevent it
Updated 7/17/22 Did you know after almost any type of cardiac surgery, it’s all too common to develop Post-Operative Atrial Fibrillation (POAF)? POAF occrus in 15%-42% of patients following cardiac surgery. (Other major surgeries can lead to Post-Operative A-Fib as well.)
Beware! If you or a loved one are having surgery, anticipate developing post-operative A-Fib. Some consider it an inevitable complication of surgery.
Both Short and Long-Term Consequences
Post-Operative A-Fib (POAF) is associated with prolonged hospital stays, higher healthcare-related costs, increased mortality, increased risk of cerebrovascular accidents (CVA), and re-hospitalization.
If you do develop A-Fib after cardiac surgery, both your short-term and long-term prognosis is poor. Increased short and long-term mortality is likely caused by heart failure, cerebrovascular accidents (CVA), and bleeding complications. Even after 10 years, you can develop “late recurrent A-Fib”.
The most common cardiac surgery in the U.S. is bypass surgery with more than 200,000 surgeries performed annually. And what’s the most frequent complication? If you guessed A-Fib, you’d be right. Rates of post-operative A-Fib after surgery range from 10%-to-50%. Those aren’t very good odds.
The Research: Post-Operative A-Fib is Dangerous
Post-operative A-Fib can be really nasty. (Don’t listen to people who say POAF is harmless and goes away soon.)
From Finland (Waterford and Ad), in a study of cardiac surgery, POAF produced a 36.5% occurrence of stroke.
In another study of over 2 million patients, POAF was associated with increased risk of early and late mortality. POAF is a strong predictor of long-term development of A-Fib (9-fold increase of the development of A-Fib more than 30 days after surgery).
From the Netherlands (Kuar, H. et al), in a small study, researchers used implantable loop recorders in cardiac surgery patients to record both early and late post-operative A-Fib (POAF). (Early POAF=within 5 days, POAF=after this period.) Over an average follow-up of 29 months, 34% of patients had early POAF, while 67% experienced late POAF.
From the University of Pittsburgh (Bianco et al), in a study involving 12,227 cardiac patients, 4,300 developed post-operative A-Fib (35.2%). These patients had significantly higher rates of re-operation, transfusions, sepsis, prolonged ventilation, pneumonia, renal failure and dialysis. On long-term follow-up, they had worse morbidity, lower survival, and more readmissions for heart failure.
From Weill Cornell Medicine, New York (Goyal et al)
“Post-operative A-Fib (POAF) occurs in up to 40% of patients undergoing heart surgery and 2% of patients undergoing non-cardiac surgery,” In an observational retrospective study of nearly 3 million patients at 11 acute care hospitals across the U.S.,18.8% of patients who underwent heart surgery developed post-operative A-Fib. “…and the risk of hospitalization for heart failure increased by a third compared to patients who did not develop AF.” Doctors tend to view POAF as a benign event, triggered by the stress of the surgery. But accoring to the authors of this study, “evidence is emerging that post-operative A-Fib is linked to longer term problems such as stroke and death from any cause.”
In an editorial by Melissa Middeldorp and Christine Albert (Cedars Sinai, Los Angeles), they suggest that POAF “is not just a transient response to surgery but may be reflective of underlying atrial and myocardial structural changes that not only predispose to the acute AF event but to other potentially related adverse events, such as Heart Failure hospitalization.”
The most disturbing point of this study is that A-Fib may itself contribute to heart failure, “post-operative AF is associated with future heart failure hospitalizations.”
Patients with A-Fib undergoing noncardiac surgery (NCS) were associated with higher risks of mortality, heart failure, and stroke. The study included 8,635,758 Medicare patients admitted for noncardiac surgery and focused on 16.4% of these patients who had A-Fib at the time of their surgery. “Pre-existing AF is independently associated with postoperative adverse outcomes after NCS.” (Prasadam S, et al) (Thanks to David Holzman for calling our attention to this research.)
Protocol to Prevent Post-Operative A-Fib
In the post-operative period, anticoagulants aren’t enough. Anticoagulation after cardiac surgery can be dangerous with a high risk of bleeding and thromboembolism (stroke).
A better stroke prevention strategy is to prevent the occurrence of POAF in the first place.
The researchers, Waterford and Ad, state that preoperative oral amiodarone is the single most powerful intervention to dramatically reduce rates of POAF.
Protocols to prevent POAF: They recommend a protocol of 400 mg oral amiodarone per day for 3 days prior to surgery, followed by 200 mg per day for 10 days through and following the operation regardless of whether or not POAF developed. They also recommend that a patient be on a beta-blocker or a statin whenever possible.
They also advise limiting blood transfusions. Red blood cell transfusion is associated with an increased rate of POAF. The mechanism is likely that red blood cell transfusion induces a pro-inflammatory state, which is known to underlie POAF.
They also urge the use of anti-inflammatory medicines such as colchicine (see my colchicine article: How to Reduce Post-Surgery A-Fib Inflammation? ).
Other Protocols: Some doctors use a beta blocker protocol before surgery such as propranolol and carvedilol plus N-acetyl cysteine which work by “attenuating the sympathetic tone.”
Study results showed that both amiodarone and beta blocker protocols had similar results in reducing poet-operative A-Fib, and that their combined use was more effective than just beta blockers (Tzoumas, A. et al).
Treatment of Post-Operative A-Fib: Some surgeons routinely discharge patients while they are still in A-Fib or Flutter. But others insist on discharging patients in sinus rhythm using electrical cardioversion. The authors, Waterford and Ad, state that electrical cardioversion “should be used more liberally.”
Editor’s Comments
Our Friend’s Bypass Surgery: On a personal note, a friend of ours recently had bypass surgery. We drove him to the hospital and were with him whenever we could. He had a hard time. He had to be put on a ventilator and was in a medically induced coma for 5 days. But he recovered and is now doing well!
I warned him about the chances of developing A-Fib after cardiac surgery, which is exactly what happened to him. But after the surgery, his surgeon got him on an amiodarone protocol which did help.
The surgeon did not use pre-operative amiodarone treatment to prevent him from developing A-Fib in the first place. That’s unfortunately what most cardiac surgical patients experience.
A-Fib After Surgery Not Benign and Transient: In the past, A-Fib after surgery was considered benign and transient. But we now know better. As described in the above research, post-operative A-Fib causes many health problems and even death.
Amiodarone Effective But Toxic and Dangerous: Amiodarone, though effective, is a very toxic drug that should only be used for a short time and under close monitoring.
Out friend was able to finally get off of amiodarone. See Amiodarone: Most Effective and Most Toxic and Toxic Effects of Amiodarone—What Could Have Prevented this Death?
Why Do So Few Surgeons Use Pre-Operative Protocols? Almost every surgeon knows that surgery often causes and/or predisposes patients to develop A-Fib. Then why do so few use pre-operative protocols to prevent post-operative A-Fib? Numerous studies show that post-operative A-Fib can be dramatically reduced by pre-operative oral amiodarone (53% to 25%) (Waterford and Ad)
Sending Patients Home in A-Fib: It’s shocking that surgeons often send their patients home while still in A-Fib! WHAT? How can they cause and/or be responsible for their patients developing a serious, dangerous heart illness like A-Fib and not do anything about it? Will your surgeon protect you from developing post-op A-Fib?
Are You Having Any Kind of Surgery? Before you have surgery, you have to ask your surgeons if they do anything to prevent you from developing A-Fib after the surgery. If you’re not confident or satisfied with their response, find another surgeon. Don’t hesitate to travel if necessary.
Developing Post-Operative A-Fib doesn’t
have to be a roll of the dice.
Talk to your surgeon about protocols to prevent it.
you should settle for nothing less.
September is A-Fib Awareness Month – Get Our Free Report for Families
When a patient is diagnosed with Atrial Fibrillation, family members often struggle to understand what their loved one is going through. With A-Fib, you don’t look sick.
While A-Fib impacts the patient’s health and quality of life, it also affects the lives (and often livelihood) of their loved ones and co-workers. They will have many questions.
September is A-Fib Awareness Month: Celebrate and Help Your Family Understand
Help your family understand how A-Fib make you feel and how it affects you.
During Atrial Fibrillation Awareness Month, we make it easy. We’ve compiled the answers to the most often asked questions from families into a special free report: The Top 10 Questions Families Ask About Atrial Fibrillation.
Download the FREE 5-page .PDF Report here-> The Top 10 Questions Families Ask About A-Fib. Print it, or, to keep a copy, SAVE the PDF to your hard drive.
Help Us Promote A-Fib Awareness
Because A-Fib runs in families, urge your immediate family members to discuss A-Fib with their doctors. Encourage your friends over 60 years old to do the same.
Pass this post on to your family, friends and co-workers. Encourage them to download the FREE 5-page PDF report The Top 10 Questions Families Ask About Atrial Fibrillation (and the Answers).
Why not post to Facebook, Twitter or LinkedIn, too? (It’s easy. Use the Share buttons below.)
♥ Share this post ♥
A-Fib Patients (and Others): Should You Be Prescribed Fewer Drugs?
Did you know you can outgrow your medication? Perhaps your lifestyle has changed with more physical activity, better nutrition or weight loss and subsequently you may no longer need medications for diabetes, cholesterol or high blood pressure.
But you keep taking them, because no one told you to stop.
Simple errors can occur, too. Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, recalled asking a patient to bring in every pill he took for a so-called ‘brown bag review’. He learned that the man had accumulated four or five bottles of the same drug without realizing it, and was ingesting several times the recommended dose.
“We spend an awful lot of money and effort trying to figure out when to start medications and shockingly little on when to stop.”
Dr. Caleb Alexander, Johns Hopkins Center for Drug Safety and Effectiveness
De-Prescribing: A Brown Bag Review
Always keep an accurate and updated list of medications you are taking. (See our free download form below.)
Periodically ask your physicians or pharmacist for a ‘brown bag review’. Discuss whether to continue or change any of your regimens. Ask about:
▪ any medicines you no longer need?
▪ any medications you can do without?
▪ if a lower dose would work for any of your medicines?
▪ if any of your medications might interact with another?
▪ any non-pharmacologic alternatives?
If your doctor agrees to ‘de-subscribe’ a medication, realize it isn’t as simple as saying “stop” taking it. It’s a process requiring caution and skill by your doctor. (Afterwards, remember to update your list of medications.)
Free Download: Keep an Inventory List of Your Medications
Keep your doctor and other healthcare providers up-to-date on all the medications you are taking by using this Medications List from Alere. Download (and remember to save the PDF to your hard drive).
Besides prescriptions, the form has sections to list over-the-counter drugs, vitamins, herbs and mineral supplements, too (as they can interact).
Print several copies of the blank form and keep handy in your A-Fib file or binder. When completed, give a copy of your inventory to each of your healthcare providers.
Also see my article: Are Your Herbal Supplements Interacting With Your Medicines?
Holiday Season Warning: How Drinking Too Little Can Trigger Your A-Fib!
With the holiday season approaching, we want to remind Atrial Fibrillation patients that cold weather, dry air and drinking too little water can lead to dehydration which can trigger an Atrial Fibrillation episode.
Many people don’t realize how quickly and deeply dehydration can set in, especially since the early warning signs are subtle.
The Good News, The Bad News
The good news is that usually dehydration on its own won’t cause an Atrial Fibrillation episode. The bad news, when combined with other well-known triggers, it will.
For example: You risk dehydration when traveling by air (low humidity) during the hectic holidays (tired and stressed), drinking too much coffee (diuretic effect), and vacationing in the desert (dry climate).
Hydration Affects the Rhythm of Your Heart
Your body contains significant amounts of water. A change in fluid levels in your body can affect a number of bodily functions, including heart function. When you have atrial fibrillation, drinking enough water is important.
When you’re dehydrated, your body’s electrolytes (electrolytes in general, and sodium and potassium in particular) are crucial for heart health. Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.
Dehydration Risk Factors Beyond Sweating and Heat
Your risk of dehydration isn’t just from sweating during exercise or from the extreme heat of summer. Other risks include high altitudes, the arid desert, exhaustion and increased stress, missing meals or a change in eating patterns, and vomiting or diarrhea.
Do you travel by plane often? Flying dehydrates you because the humidity level on a plane is usually less than 10%. How about your choice of beverages? Alcohol and caffeinated drinks also dry you out.
Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and works less to keep ideal fluid balance. And since you don’t feel thirsty when it’s cold, you often don’t think about drinking extra water.
A-Fib Patients: Preventing Dehydration
Under normal conditions, 64 to 80 ounces of water per day is considered enough. On a plane, a good rule of thumb is 6 to 12 ounces of water (or club soda) for every hour in the air.
Drink at least 64-80 oz of water a day or more when…
Be aware of the not-so-obvious signs of dehydration: dry mouth, constipation, feeling tired and sleepy, low urine output, dry skin and dizziness or lightheadedness. Furthermore, your body may misinterpret the need for water as the need for food making you feel hungry, when what you really need is more water.
Drink more water when…the weather is too hot or too cold, when traveling by plane, when you’ve skipped meals, when exhausted or you’re sick. For each coffee or alcohol beverage, have a glass or two of water.
Check your hydration level. Each body has individual needs for water intake. If you’re drinking enough, look at the color of your urine when you go to the washroom. If your urine is clear or light yellow, you are well hydrated. If it’s darker, you need to drink more water.
Stay Aware—Stay Hydrated
Dehydration is never a healthy state, but the mineral imbalance that results can be especially troublesome for A-Fib patients. Sometimes it’s the lack of a dietary staple that causes the heart to misfire, and in many cases, that substance is water.
A-Fib Self-Care Skills: How to Check Your Heartbeat and Heart Rate
Some Atrial Fibrillation patients know immediately when their heart is in A-Fib. They experience one or more symptoms including shortness of breath, palpitations, heart flutters, etc. Other A-Fib patients may have subtle symptoms (or silent A-Fib) and can’t be sure.
The following self-care skills will reassure you any time you suspect you’re in A-Fib—how to check for an irregular heartbeat and how to tell if your heart rate is too fast or too slow.
Self-Check if Your Heartbeat is Regular or Irregular
I found an informative post with these self-care skill steps on the Scope Blog by Stanford University School of Medicine. To check whether your heartbeat is regular or irregular:
♥ Begin by placing your right hand on the left side of your chest while seated and leaning forward.
♥ Position your hand so that you feel your heartbeat most strongly with your fingertips.
♥ A normal heart rhythm should feel like a regular drum beat cadence; you can usually anticipate when each beat will come after the last beat.
♥ Because heart rate and the strength of the heartbeat can vary with breathing, sometimes holding your breath for a few seconds is helpful. With an irregular rhythm, it will be hard to predict when the next beat will come.
♥ In addition, some irregular beats will be softer (less strong) than other beats, so the strength as well as the timing may not be consistent.
Self-Check If Your Heart Rate is Too Fast or Too Slow
The Stanford blog continues with a second set of self-care skill steps—how to measure if your heart rate is too fast or too slow so you know when to seek medical care. (An optimal heart rate is 50–100 bpm when you are at rest.) To check your heart rate:
♥ Place your right hand over your heart so that you feel your heart beating under your fingertips.
♥ Use a watch or timer and count the number of beats for 15 seconds.
♥ Be sure to count all heartbeats; including beats that are not as strong or that come quickly following one another.
♥ Take the number of beats you’ve counted and multiply it by four. For example, if you count 30 beats in 15 seconds, then you would calculate 4 x 30 = 120 beats per minute.
♥ Repeat this process three times right away, writing down each heart rate to later share with your doctor.
While an Electrocardiograph (ECG or EKG) or Holter monitor are the only sure ways to document you are in A-Fib, you can use the above self-care skills to recognize A-Fib symptoms of an irregular heart beat or if beating too fast or too slow.
These skills with help you remain calm and confident when you suspect you may be in A-Fib.
Are Your Herbal Supplements Interacting With Your Medicines?
Many people take herbal or dietary supplements along with their prescription medicines. But medicines and supplements may interact in harmful ways!
Some supplements can decrease the effects of medicines, while others can increase the effects, as well as cause unwanted side effects.
The medicines affected have a ‘narrow therapeutic index’, which means that if the amount of the drug is even a little too low or too high, it can cause big problems.
Warfarin (Coumadin) is one such medicine. When taken with certain herbal supplements, such as Asian ginseng or St. John’s Wort (and possibly ginger), you may need to be closely monitored.
St. John’s wort, for example, interacts with many types of drugs. In most instances, it speeds up the processes that change the drug into inactive substances, leading to a decrease in drug levels in your body.
Other medicines with a narrow therapeutic index include digoxin (heart), theophylline (asthma), lithium (anti-depressant), acetaminophen (pain killer) and gentamicin (antibiotic).
The herb-drug interaction potential is high for St. John’s Wort, Asian ginseng, Echinacea, ginkgo (high dose) and goldenseal; But low for black cohosh, ginkgo (low dose), garlic and kava supplements.
Take an Inventory
If you take any of the described medicines and herbal supplements, use our free Medication Inventory form to make a list of everything you take.
List how often you take them, and the doses you take.
Then ask for a review by your doctor or pharmacist for any harmful interactions. You may find you want to modify your supplement regime.
Do Your Own Research
Learn more about herb-drug interaction potentials at:
• Herb-Drug Interactions: What the Science Says. National Institutes of Health/National Center for Complementary and Integrative Health.
• About Herbs, Botanicals & Other Products“ at the Memorial Sloan Kettering (MSK) website (one of our favorites).
Don’t be Fooled by the Numbers in Drug Ads: How You Get to the Absolute Truth
A while back we posted, Don’t be Fooled by Pay-to-Play Online Doctor Referral Sites, about how it’s common for doctors to pay io be listed in online doctor referral services. (Doctors can pay extra to be listed first in your database search results.)
How Some Drug Ads Mislead
This time we caution you about how some drug ads mislead you.
Here’s an example of an actual news report headline, “New Wonder Drug Reduces Heart Attack Risk by 50%.” Sounds like a great drug, doesn’t it?
Yet it sounds significantly less great when you realize we’re actually talking about a 2% risk dropping to a 1% risk. The risk halved, but in a far less impressive fashion.
A factual headline would be, “New Wonder Drug Reduces Heart Attacks from 2 per 100 to 1 per 100.” Doesn’t sound like such a great drug now, does it?
The online watchdog group HealthNewsReview.org reports, that’s why using “absolute numbers” versus percentages matter. “Absolute numbers” provide you with enough information to determine the true size of the benefit.
The Tale of a 50% Off Coupon
Professors Steve Woloshin and Lisa Schwartz of the Dartmouth Institute for Health Policy & Clinical Practice explain absolute numbers versus percentage (relative numbers) in a creative way.
“… [it’s] like having a 50% off coupon for a selected item at a department store. But you don’t know if the coupon applies to a diamond necklace or to a pack of chewing gum.
Only by knowing what the coupon’s true value is—the absolute data—does the 50% have any meaning.”
So, 50% off a diamond necklace might be a savings of $5,000. While 50% off a pack of gum might be 50 cents. Absolute numbers tell the whole story.
The Bottom Line: Be Skeptical, Ask Questions
As a healthcare consumer, it’s wise for you to be skeptical anytime you hear a benefit size expressed as a percentage, for example, a 50% improvement or 50% fewer side effects.
You should ask yourself 50% of how many? Of 10,000 patients? Or 10 patients? Which result is significant and which is just blowing smoke?
Numbers matter. That’s how you get to the absolute truth.
Additional Reading
See also How to See Through the Hype in Medical News, Ads, and Public Service Announcements, my review of the book “Know Your Chances―Understanding Health Statistics”.
The Math Behind a 50% Reduction
“New Wonder Drug Reduces Heart Attack Risk by Half.” How was this claim calculated?
The Raw Data: In the research study, the 5-year risk for heart attack for:
-a group of patients treated conventionally was 2 in 100 (2%) and
-a group of patients treated with the new drug was 1 in 100 (1%).Absolute Difference: The absolute difference is derived by simply subtracting the two risks: 2% – 1% = 1%. Expressed as an absolute difference, the new drug reduces the 5-year risk for heart attack by 1 percentage point (or 1 in 100).
Relative Difference: The relative difference is the ratio of the two risks. Given the data above, the relative difference is: 1% ÷ 2% = 50%. Expressed as a relative difference, the new drug reduces the risk for heart attack by half, or 50%.
Absolute Numbers Versus Percentages:
How the numbers work (or mislead the reader)
Polypharmacy: A Cautionary Tale of Taking Too Many Prescription Drugs
Tracking prescription drug use from 1999 to 2012 through a large national survey, Harvard researchers reported that 39 percent of those over age 65 now use five or more medications— a 70 percent increase over the 12 years tracking period.
“Polypharmacy” is the term for prescribing patients five or more medications at the same time (even if all are given for legitimate reasons).
This often happens when a person has many chronic diseases, such as diabetes, high blood pressure and heart disease, each requiring long-term treatment with medications.
What’s the Problem?
First, drugs are chemicals that can interact with one another with the potential to cause all kinds of complications (versus if you take just one medication).
For example, an anti-inflammatory medication like Ibuprofen (Advil, Motrin, Midol, Nuprin), may increase blood pressure and worsen kidney function. Therefore they should not be used by persons with high blood pressure or kidney problems.
Next, as we age, the kidneys and liver become less efficient in passing medications out of the body. The lingering drugs can magnifying their effects as well as have side effects.
Polypharmacy contributes to higher rates of hospitalizations and death, and higher costs.
Should You Be Prescribed Fewer Drugs?
Some people outgrow their medication. They change their lifestyle (ex. diet, physical activity, and weight loss) and subsequently may no longer need medications for diabetes, cholesterol or high blood pressure.
But they keep taking them, because no one told them to stop.
Simple errors can occur, too. Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, recalled asking a patient to bring in every pill he took for a so-called ‘brown bag review’. He learned that the man had accumulated four or five bottles of the same drug without realizing it, and was ingesting several times the recommended dose.
De-Prescribing: A Brown Bag Review
Always keep an accurate and updated list of medications you are taking including over-the-counter drugs, herbal products, and supplements. Give your doctors each a copy. (See our free download form below.)
Periodically ask your physicians or pharmacist for your own ‘brown bag review’. Discuss whether to continue or change any of your regimens. Ask about:
▪ any medicines you no longer need?
▪ any medications you can do without?
▪ if a lower dose would work for any of your medicines?
▪ if any of your medications might interact with another?
▪ any non-pharmacologic alternatives?
If your doctor agrees to ‘de-subscribe’ a medication, realize it isn’t as simple as saying “stop” taking it. It’s a process requiring caution and skill by your doctor. (Afterwards, remember to update your list of medications.)
“We spend an awful lot of money and effort trying to figure out when to start medications and shockingly little on when to stop.”
Dr. Caleb Alexander, Johns Hopkins Center for Drug Safety and Effectiveness
Free Download: Keep an Inventory List of Your Medications
As a service to atrial fibrillation patients, we offer Free Reports, Worksheets and Downloads of our own worksheets and articles and useful free services or downloads from others serving the atrial fibrillation community.
Inventory List of Your Medications: We want to help you keep your doctor and other healthcare providers up-to-date on all the medications you are taking by using this Medications List from Alere.
Download and use to help you keep track of everything (including over-the-counter drugs, vitamins, herbs and mineral supplements, too). Remember to save the PDF to your hard drive.
Because your medications will change over time, print several copies of the blank form so you will always have a clean copy ready to use. (Keep in your A-Fib file or binder.) Give a copy to each of your doctors or other medical healthcare providers.
Vitamin K―Protection Against Arterial Calcification & Cardiovascular Disease
Most people get just enough Vitamin K from their diets to maintain adequate blood clotting.
But NOT enough Vitamin K to offer protection against health problems including arterial calcification, cardiovascular disease, osteoporosis, various cancers and brain health problems, including dementia.
The name Vitamin K comes from the German word “Koagulationsvitamin” where its role in blood coagulation was first discovered.
Vitamin K is an essential vitamin. It is one of the four fat-soluble vitamins, along with vitamin A, vitamin D, and vitamin E. It’s found in leafy green vegetables, broccoli, and Brussels sprouts.
Vitamin K and Vitamin K supplements come in several forms and can be confusing. To increase your levels of Vitamin K, it’s important to understand the differences.
Vitamin K Can be Classified as Either K1 or K2
Vitamin K1: Found in green vegetables, K1 goes directly to your liver and helps you maintain a healthy blood clotting system; keeps your own blood vessels from calcifying, and helps your bones retain calcium.
Vitamin K2: Bacteria produce this type of Vitamin K; it goes straight to vessel walls, bones and tissues other than your liver. It is present in fermented foods, particularly cheese and the Japanese food natto (the richest source of K2).
Different Forms of Vitamin K2
Making matters even more complex, there are several different forms of Vitamin K2. MK-4 and MK-7 are the two most significant forms of K2 and act very differently in your body.
MK-4 is a synthetic product, very similar to Vitamin K1, and your body is capable of converting K1 into MK4. It has a very short biological half-life of about one hour, making it a poor candidate as a dietary supplement. It remains mostly in your liver where it is useful in synthesizing blood-clotting factors.
MK-7 is a newer agent with more practical applications because it stays in your body longer; its half-life is three days, meaning you have a much better chance of building up a consistent blood level, compared to MK-4 or K1. It slows down cardiovascular aging and osteoporosis, and prevents inflammation by inhibiting pro-inflammatory markers produced by white blood cells.
Food Sources of Vitamin K and MK-7
Photo by Like_The_Grand_Canyon on Flickr licensed CC-BY
MK-7 is extracted from the Japanese fermented soy product called ‘natto’. You get loads of MK-7 from natto. However, natto is generally not appealing to a Westerner’s palate (can’t tolerate its smell and slimy texture).
You can also find Vitamin K2, including MK-7, in other fermented foods including some fermented vegetables.
Certain types of fermented cheeses (Jarlsberg) are high in K2 but others are not. It really depends on the specific bacteria. You can’t assume that any fermented food will be high in K2.
Besides broccoli, Brussels sprouts and leafy green vegetables (kale, mustard greens, collard greens, raw Swiss chard, spinach), other foods high in Vitamin K include beef liver, pork chops and chicken, prunes and Kiwi fruit, soybean and canola oil.
Vitamin K Supplements
Choosing a K2 supplement: When supplementing your Vitamin K food sources, consider a high quality MK-7 form of vitamin K2. (Plus, as they are inexpensive, include Vitamin K1 and MK-4 to help inhibit and possibly reverse vascular calcification.)
Dosage: Although the exact dosage of Vitamin K is yet to be determined, one of the world’s top Vitamin K researchers, Dr. Cees Vermeer recommends between 45 mcg and 185 mcg daily for normally healthy adults.
My choice: I’m taking Relentless Improvement Vitamin K2 MK4 Plus MK7; Read about it on Amazon.com. David Holzman writes that he uses Whole Foods Vitamin K2 which is less expensive. (Use our portal link to Amazon.com and support A-Fib.com)
(If you have a K2 supplement recommendation, email me.)
Remember!
Always take your Vitamin K supplement with food that contains fat
since it is fat-soluble and won’t be absorbed without it.
Read more about mineral deficiencies and Atrial Fibrillation, see FAQs: Mineral Deficiencies & Supplements for a Healthy Heart
This article is based on Dr. Mercola’s article, New Study Shows Evidence That Vitamin K2 Positively Impacts Inflammation.
How Drinking Too Little Can Trigger Your A-Fib
Drinking too little alcohol? Coffee? Juice? No, we’re talking about just plain ol’ water. Drinking too little water leads to dehydration which can trigger an Atrial Fibrillation episode, and raises the risk for blood clots (it makes the blood thicker and more viscous).
Hydration Affects the Function of Your Heart
Your body contains significant amounts of water. A change in fluid levels in your body can affect a number of bodily functions, including heart function. When you have atrial fibrillation, drinking enough water is important.
When you’re dehydrated, your body’s electrolytes (electrolytes in general, and sodium and potassium in particular) are crucial for heart health. Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.
Dehydration Risk Factors
Your risk of dehydration isn’t just from sweating during exercise or from the extreme heat of summer. Other risks include high altitudes, the desert, exhaustion and increased stress, missing meals or a change in eating patterns and vomiting or diarrhea.
Do you travel by plane often? Flying dehydrates you because the humidity level on a plane is usually less than 10%. Alcohol and caffeinated drinks also dry you out.
Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and works less to keep ideal fluid balance. And since you don’t feel thirsty when it’s cold, you often don’t think about drinking extra water.
The Good News, The Bad News
The good news is that usually dehydration on its own won’t cause an A-Fib episode. The bad news, when combined with other well known triggers, it will.
For example, you risk dehydration when traveling by air (low humidity) during the hectic holidays (tired and stressed), drinking too much coffee (diuretic effect), and vacationing in the desert (dry climate).
Preventing Dehydration
Under normal conditions, 64 to 80 ounces of water per day is considered enough. On a plane, a good rule of thumb is 6 to 12 ounces of water (or club soda) for every hour in the air.
Be aware of the not-so-obvious signs of dehydration: dry mouth, constipation, feeling tired and sleepy, low urine output, dry skin and dizziness or lightheadedness. Furthermore, your body may misinterpret the need for water as the need for food making you feel hungry, when what you really need is more water.
Drink more water when… the weather is too hot or too cold, when traveling by plane, when you’ve skipped meals, when exhausted or you’re sick. For each coffee or alcohol beverage, have a glass or two of water.
Check your hydration level. Each body has individual needs for water intake. If you’re drinking enough, look at the color of your urine when you go to the washroom. If your urine is clear or light yellow, you are well hydrated. If it’s darker, you need to drink more water.
Be Aware—Stay Hydrated
Sometimes it’s the lack of a dietary staple that causes the heart to misfire, and in many cases, that substance is water.
As fatigue or muscle ache turns into thirst, you’re already pretty far down that path to dehydration. Many people don’t realize how quickly and deeply dehydration can set in, especially since the early warning signs are subtle.
Dehydration is never a healthy state, but the mineral imbalance that results can be especially troublesome for A-Fib patients.
