Frankye Myers: From Riverside Health, this is the Healthy you podcast, where we talk about a range of health-related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
Frankye Myers: All right. I'm really excited to have with me in the healthy youth studio, Kim Liebold.
Kim Liebold: Liebold.
Frankye Myers: Thank you, Kim.
Kim Liebold: You're most welcome.
Frankye Myers: Kim is a nurse practitioner with Riverside. Cardiology specialist. Welcome.
Kim Liebold: Thank you.
Frankye Myers: We're going to be talking about heart rhythm and navigating slow and fast heartbeats, right?
Kim Liebold: Yes. Yeah.
Frankye Myers: Great. Great. Welcome to the Healthy you podcast. I am your host, Frankie Myers. And today we're going to be diving into those rhythms. Rhythms a little bit more specifically, and the differences between slow and fast rhythms known as brady and tachycardia. Understanding these can be life changing, whether someone who experiences these conditions or curious about health and heart related issues. Thank you so much for joining me.
Kim Liebold: Thank you. My pleasure.
Frankye Myers: Tell me a little bit about how you ended up in this field.
Kim Liebold: Well, I guess I would have to go back to when I was a little girl. My grandmother always wanted to be a nurse. I was born and raised in Smithville. She always wanted to be a nurse. And at that time, she wasn't able to go to nursing school because of some commitments. She needed to take care of some family members. So, as I grew up, she was one of those caregivers in the community that would always be called on when they needed somebody to come and sit. At that time, we didn't have home health, so she was always somebody who did it and always wanted me to be a nurse. So I actually went into nursing school here at Riverside 40 years ago.
Frankye Myers: Wow.
Kim Liebold: And went there and primarily got into cardiology because of a wonderful biology teacher in high school and a wonderful, awesome teacher at Riverside nursing school who just made the heart seem very exciting, very challenging, and just made it kind of flow and made it easy. So as soon as I got out of nursing school, I went right into CCU and have been in cardiology for the last 30 plus years. Okay.
Frankye Myers: We've got some similar background going on there. My grandmother was an LPN, and so I always knew I wanted to be a nurse. And then my mother attempted to go to nurses school, and she wasn't successful due to some family stuff. So that's why we have children and have legacy. They can finish what we. We can finish what they weren't able to.
Kim Liebold: And I was very fortunate because when I worked in Riverside and CCU, I left the hospital to go into what is now Riverside cardiology specialist.
Frankye Myers: Okay.
Kim Liebold: I've been in that office for a little 35 years and worked with some amazing cardiologists. And one in particular, Doctor McLaurin, who's no longer with us, was just an inspirational person who just looked and was very innovative. And he wanted me to go back to school and be a nurse practitioner. And at that time, there were no nurse practitioners in this area other than the important ones of family practice, women's health and pediatrics and psych. And those are the only specialists. So he encouraged me, and two of the cardiologists that are still with me working today, doctor Edwards and Doctor Vaughn, encouraged me as well and supported me. And when I came back, was able to get into cardiology and have been a nurse practitioner there for 27 years.
Frankye Myers: Wow.
Kim Liebold: So cardiology was the first nurse practitioners in specialty, and now it's just amazing to watch all the amazing akps that are here and supporting the health system.
Frankye Myers: Yeah, absolutely.
Kim Liebold: So it's an honor for me.
Frankye Myers: I'm a former CCU nurse. And to your point, when you look at heart hospitals, you see a lot of nurse practitioners and pas working with those cardiologists now because they need that support when they're in surgery to manage clinics, etcetera. All right. There are many types of arrhythmias, and so let's dive into a little discussion about that, and then we're going to keep it where our viewers can kind of understand, because there's some long terminology to some of these rhythms.
Kim Liebold: Yes. So I think when we always talk about arrhythmia is you have to kind of start to understand what is an arrhythmia to know how to. To categorize them. So we just remind people that the heart has its own electrical conduction system. So most people, when they think of heart disease, think of the circulation, if there's a blockage or a heart attack, and that's more the plumbing aspect of the heart. We work and focus on the electrical aspect of the heart, and that is when the heart's rhythm, it starts in the top chamber of the heart, called the atrium. It has its own natural pacemaker, which is a group of cells that are specialized to produce signals to go down to the bottom chamber of the heart to create the heartbeat. And so it is a wonderful system that produces heart rates that should be about 60 to 100 beats per minute. And it should be regular, and so that's your normal conduction system. So an arrhythmia is anything that's different than that. So if something is faster or slower or if something is offbeat, then we consider that arrhythmias, and there's different kinds of arrhythmias. As you said, they're classified differently.
Frankye Myers: Okay. And so for our viewers, you would think that you'd have to have a lot of technology to be able to determine if you have arrhythmia. What are an arrhythmia? Aren't there some signs that they can see without having, you know, sophisticated technology? Maybe. You know, some people feel like, hey, I feel like my heart's skipping a bit or they may feel winded. I don't know if you want to talk about some of those things.
Kim Liebold: Yeah, absolutely. So, basically, I think the important thing is knowing yourself and knowing your body. And again, that's important part of keeping up with your healthcare, seeing your primary care physician and knowing what is your natural heart rate, pulse, what is your blood pressure. And so for rhythms, there are some people who can have. And we'll focus on slow heart rates first, there's some people who can have slow heart rates that are very natural to them. That is no harm and creates no symptoms. And those are people you think about that are maybe the athletes that are marathon runners or long distance swimmers or bikers, and they're just really conditioned and they run around with heart rates in the forties, and that's absolutely acceptable and fine. But then there are those people who have slower heart rates that may have symptoms, and those are the ones that we want to focus on and be aware of and come to your family doctor and have it checked out. And some of the symptoms they could have could just be as simple as just feeling more tired, just feeling like they can't do what they normally could. Like sometimes I say it's like you're hitting a brick wall that you just can't get across the room or you can't do an activity. Other times, it could be shortness of breath, it could be lightheadedness or dizziness, even fainting, which is very concerning. And it can be for some people who may have other disease process, like coronary disease, they may get chest pain because of slow heart rates. And so going to the doctors and getting simple tests like an EKG, which allows us to look at the electrical activity and see what is really going on with that slow heart rate. So that's kind of more from the slow heart rate standpoint, some things that we do to treat that, if it's truly related to maybe a medicine, they're on, because there's some blood pressure medicines called beta blockers or calcium channel blockers, they will slow the heart rate down. So if they don't need that particular medicine, we take those off and they can use other medicines for. For that. But if they need that to treat their coronary disease or whatever, then sometimes we need to help them with what we call a pacemaker. And a pacemaker is something that we do quite frequently. I work with an amazing electrophysiology team at Riverside. Doctor Aladini and doctor Abezziki are our two eps. So we call those our electricians. And I have two other wonderful apps that work with us to make the team, and we basically work with those patients. It's a minimally invasive procedure where we literally just kind of place a lead in the top and bottom chamber of the heart, if that's what they need, and then a small pacemaker that's about the size of 250 cent pieces kind of glued together.
Frankye Myers: It helps regulate the heart. When it's not doing it for you, the next device will do it for you. Correct.
Kim Liebold: So it basically is the safety net. So if your heart rate won't stay above 60, and that's what we typically set it at, and your heart rate wants to be 40, then this will not allow it to be under 40. It's going to pace it and produce the signal that your natural heart doesn't. So it still will allow your heart to go fast if you're one of those people that have fast heart rates, and then we are allowed to treat that with other ways safely because we know we're not going to make that heart rate go too slow. So that's a pacemaker. And the technology now is people can have pacemakers and do all kinds of things with these.
Frankye Myers: And isn't that a last resort? So you guys do a lot of testing to rule out other things, like medication?
Kim Liebold: Absolutely. If we don't have to do a pacemaker, that's we can switch medications, we can look and see if this is something that is fixable and resolved. But if not, and they continue to have slow heart rates that are dangerous or concerning that would, you know, create other problems for them, then a pacemaker is certainly an option for them.
Frankye Myers: Okay, what about atrial fibrillation and atrial flutter, which, you know, I remember, you know, early on in my nursing career, they used to call it the caffeine. The caffeine outcome. Talk a little bit more about that. I think it's a combination sometimes of stress and caffeine or other factors.
Kim Liebold: I'll be glad to. And actually, I didn't know this when we set this up, but September is actually 8th of awareness month, so perfect, perfect timing. We knew that, you knew that. So when we categorize AFib and a flutter that usually comes in for the most people, the fast heart rates, and there's lots of different fast heart rates, like we had said earlier. And those can be things that, again, create symptoms, such as palpitations, fast heartbeats, a fluttering sensation. Some people can get short of breath, dizzy, lightheaded, some people can faint with those if they're really fast, and some people can have chest pain and other things. So any, again, symptom that, you know your body, that's when you just really need to go see your doctor. They can do the EKG and determine what kind of fast heart rate this is. And it depends on where it originates. And we'll focus on the top chamber of the heart, where the AFIB comes from. And some can be regular and they can be used medicines to slow them down. And then sometimes there's procedures that are called ablations that we can do to help. Some of those fast heart rates, specifically for those would be like svts, which people, and even young people will have those where it just starts like a light switch, it just comes on, it's really fast, and then it sometimes will just go away. And if it doesn't go away, it can be, you know, quite problematic. And it creates a lot of, er, visits that population of people do very well with ablations, and those are procedures that are minimally invasive, where electrophysiologists, again, take a catheter up to the heart, locate these excitable areas that are outside of our conduction system, that are messing up our conduction system, and they will actually destroy them with radio frequency heat. They basically get physiology, so they're able to get rid. So they find that spot and they get rid of it, and then it doesn't allow any competition to our conduction system. So then we can go about our normal atrial fib is probably the one that we concern about and we deal with most because it is the most common rhythm, other than normal rhythm.
Frankye Myers: Is it true that it's common, but it can be have a negative outcome if not treat it, because you can form clots.
Kim Liebold: Absolutely and absolutely. That's what sets itself. That's what sets itself above any of the other arrhythmias that we really deal with, because some people feel it and they're extremely symptomatic, just, like I said, with any fast heart rhythm. But other people don't have any clue that they have it. We can see them and have heart rates of 180 beats per minute, and they don't have a clue. The difference of atrial fibrillation is that it is multiple sites in the top chambers of the heart that are just sending all kind of chaotic electrical activity down to the bottom chambers. So they're trying to respond to everything that's coming. And what you get is this very irregularly irregular, chaotic rhythm. And as the heart is trying to process the blood in the heart, it's not. It's not able to do its in a normal fashion, and blood clots can form and then it can get pushed out of the heart, and the first stop is the brain. And so, unfortunately, atrial fibrillation causes an increased risk by five times an average person for a stroke. So our goal is, you know, you think something's going on, get identified, go to your doctor, go to urgent care, go to the ER, get it diagnosed, even if you don't feel it. We need to protect you from a stroke. The way we do that is much easier nowadays than it used to be. It's the anticoagulation or the blood thinners that people think about. In the old days, all we had was warfarin or coumadin.
Frankye Myers: Yes.
Kim Liebold: But now we have the direct oral anticoagulants, which is xeralto a river, roxaban and apixaban, which is eliquis. And those are ones that we are able to give and doesn't interfere with their diet and really doesn't interfere with other medicines and is much easier for them to be on and stay on, and that protects them from a stroke the best we can now, medically, which is really amazing.
Frankye Myers: Yeah, that's great.
Kim Liebold: So it helps them, you know, not have a stroke, and then we can concentrate on the AFib. What can we do about that? And that treatment is pretty like the others. There's medications we look for other causes that could be going on and try to get rid of those. And then again, ablation is certainly an option for that. If a medication that we call an antiarrhythmic doesn't quiet it down and keep you out of it.
Frankye Myers: Yeah. I don't know how you feel about this, but even for myself as a healthcare professional, I realized not too long ago I'd never had a baseline EKG. And it's not one of the things that we talk about when we talk about prevention like we do with some of the other.
Kim Liebold: Right? Yes, and I agree. And I always like to people to have their own kind of copy of their EKG, just to have for their baseline. And sometimes they can. Nowadays, with our technology, I have more and more patients coming in the office with their smartphones and with apps on their phones or with the apple watches, where they're getting rhythm strips, which is what they are. Some of the ones can have a little bit of like a three lead or six lead system that's kind of a mimic of a twelve lead. But those are very important to do, especially if you think something's going on. I do want to say with AFib, because there's a huge population of people, and I don't want them to listen to this and think, oh, my God.
Frankye Myers: That are being maintained.
Kim Liebold: They are. They absolutely live with AFib for years and years and years, and that's absolutely fine. As long as people have protection from a stroke, their rate is controlled and not going fast so that it doesn't, you know, create burden on the heart. Thinners are on, and we always check the heart muscle strength to make sure that it's not negatively affecting the heart. Those people can live with AFib the rest of their life, and studies show that they do just as well. We just have to keep an eye to make sure that they're always on their blood thinners and that they are safe with those and that their rates are controlled.
Frankye Myers: You talked a little bit about who may be prone. Has the research really solidified? Like, what is the real cause? Is it family history? Is it stress? Is it diet? You know, like, yeah, I think there's.
Kim Liebold: Certainly some identifiable risk factors for AFib, and it kind of talks, and then when we start working with people, we try to kind of reduce those done. We know that people who have coronary disease, who've had heart attacks, particularly if they've had, like, damage to the heart muscle and they have scar there from a heart attack that will allow them to have more arrhythmias. If people have untreated diabetes, hypertension, those type of things certainly all factor into it. Some of the things that we see quite a bit nowadays is sleep apnea. It's a very popular. I think you had a session not too long ago with Doctor Givens, who is wonderful, who does sleep studies for us. And I think they identify probably just as much AFib as we do, because as the heart gets irritated from having a lack of blood flow. When the people stop breathing at night with their apnea, then that triggers AFib. And so we, a lot of times will send people, when they get diagnosed with AFib, to find out that they truly actually have sleep apnea. If we treat the sleep apnea, a lot of times, we can keep the AFib under nice control or it not come back. So that's certainly things, other things that, like thyroid disorders, things that can kind of trigger metabolism, keeping those in check. So a lot of those things are factors that do it. And then there is some concern about some hereditary, different things that can affect AFib and make us a little bit more prone to it.
Frankye Myers: Wow, that's great information. As it relates to initial diagnosis. What are some of the. I hear people who go on, like, monitoring over time and keep a diary, and all of those things work.
Kim Liebold: So how do we initially diagnose? Yeah, so, usually by the time they come to us in electrophysiology, they've seen their primary care physician, who's called caught it on an EKG or an exam, or they go in for a surgical EKG, for clearance for a surgery, and then they go, whoops, you have AFib. Or. Unfortunately, we work a lot with our neurointerventionalists at Riverside, and we see them as they come in with a stroke and trying to figure out why did they have the stroke and sometimes can see it. What we usually do in workup is basically do the twelve lead EKG. We do a halter monitoring. There's all kinds of external monitoring that we can put in for long term heart monitoring to capture it, because some people will have AFib. And this is your stroke patients that may not have it all the time. They may have it for 30 minutes and then not have it again for months. And it's very hard to capture. So there's long term heart monitors that we can put on externally, that they can wear up to 30 days. And we look to see if we capture any AFib in that timeframe. If not, we actually have a little small one that we can put under the skin that's about the size of a paper clip that will watch the heart monitor for three and a half years. So we do that for people that are high risk, that we haven't identified, maybe the reason of their stroke. But once we identify it, we look to see again, how much do they have? How fast is it? How is it bothering them? And then we help develop the treatment plan that's very individual for each person.
Frankye Myers: That’s great information, Kim. So for someone, we all have something potentially in our family history. And as you think about preventing it from becoming an actual problem for you, what are some things that you think you could educate our viewers on that if you want to be proactive? I know I have to watch my caffeine. I'm already hyper. And if you have stressful jobs, how do you control exercise? Are there things that people can do if they want to live a life of. I'm aware that it could potentially be a family history, but I want to avoid it actually becoming an issue in their own life.
Kim Liebold: I think, like most of the heart healthy things that we do or just healthy in general, trying to maintain a good balance of exercise, a good heart healthy diet, or weight in a normal weight range, trying to avoid a lot of caffeine type products nowadays, unfortunately, in our society, we do have a lot of energy drinks for these shot and energy drinks. And we are all kind of working all the time and utilize some of those. And all those are stimulants, sometimes over the counter medications for cough and cold. Have these over the counter pseudo ephedrine and things that can rev up the heart and increase blood pressure. And so I always encourage the patients to go or people to go to the pharmacist and say, you know, I have a history of blood pressure. What can I take? So avoiding those things, and again, like we said, if you have known risk factors, diabetes, hypertension, keeping those in really good control and managing those with your healthcare provider reduces your risk for AFib burden or other arrhythmias in some situations.
Frankye Myers: That's great information. I think it's all about just trying to live an intentional life. Because I start over every morning, I'm going to exercise three days a week.
Kim Liebold: Right. It's easier said than done, and I.
Frankye Myers: Don't get one day in, but I keep waking up being intentional, always the first day. So, Kim, that is great information. Anything else that you can think of that you'd like to impart upon our viewers?
Kim Liebold: I think the only other thing that I have a very passion for, and it kind of goes to a little bit of a different type of heart rhythm. That's the bottom chamber rhythm called ventricular. Ventricular. Bottom chamber ventricular rhythms. And they typically are very fast rhythms. Those are the most dangerous and are life threatening rhythms.
Frankye Myers: Why is that, Kim? Is it because it's the output, the blood, correct?
Kim Liebold: Yes, ma'am. So it basically is as the bottom chamber is beating really, really fast, and it's originating in the bottom chamber, not allowing the conduction to come from the top, but the rhythm is coming from the bottom chamber. It is beating so fast that the heart's not filling up with blood, so it's not pumping efficiently. So even if you have a pulse with it, it's not sometimes an effective pulse. And people will get really symptomatic chest pain, shortness of breath, feel like they're going to pass out. Or if it goes really fast and goes into fibrillation, that's ventricular fibrillation. That's sudden death, because there is no pulse. So, in those kind of situations, obviously for ventricular tachycardia, people have that and can have symptoms in CS and do okay with medications, and we even do ablations on those as well. But the ventricular fibrillation of sudden death can come from unawareness. And if people have a weakened heart muscle, like your athletes and things that you don't know about, it can come from people who have coronary disease or a heart attack at the time. So there's a lot of ways that happens. My focus is, we can do amazing things at Riverside now between our cardiology interventionalists and our EP doctors, but we have to get them to us first. And so for the community awareness of getting involved, if you see somebody who has gone down, if somebody drops in front of you, particularly an adult or a teenager, you want to go to them immediately, and you want to see if they are responsive. If they are not responsive, you want to immediately call 911. And as you call 911, the dispatcher, and we now have our cell phones all on us. We can, you know, just go on speakerphone, and we start hands only CPR. So everybody can do it. You can go on the American Heart association website in 90 seconds, learn how to do it. And it's putting your hands and pushing down on the center of the chest hard and fast to 100 to 120 beats per minute. We all think of staying alive.
Frankye Myers: Yes.
Kim Liebold: That's the tempo you do. And you just do that until help arrives. And what you're doing is you're circulating. You are that person's circulation, and you are circulating oxygenated blood that's in their system to their brain until help can come. The other piece to that is knowing how to use AEDs, which are the automatic external defibrillators, which I think of are the little red boxes that are most places. So I always encourage people, know where you are, know where your red box is, look for it. But they aren't designed to sit on the wall and wait for the ambulance to come or healthcare people to get there. They're designed for laypeople. And so learning how to just know when is appropriate to start CPR, get somebody to bring you the AED, cut it on, because when you cut it on, it tells you everything to do. And it is designed to work for CPR cannot help. CPR is going to circulate, but it's not going to start the heart back. What you're doing is you're holding that person in a pattern of oxygenation to the brain while you're waiting for that defibrillator to get there. So 911 will bring it. But if it's in your community, in your facility, you can do it immediately and save lives.
Frankye Myers: Absolutely.
Kim Liebold: And the thing for me is 70% of people, it's the home where cardiac arrest occurs or the workplace or a community event. And so it's not in the hospital that it happens. It's in the community. So knowing hands only CPR, knowing how to use an AED, where your aeds are, makes a huge difference. And people survive and do very well. And it's just something that I very feel very passionate about. And we work with teenagers and teach kids. And actually now in the state of Virginia and public schools, you have to pass and have hands only CPR and AED awareness to graduate. So it shows that this is something that's just really important in our society and makes a difference.
Frankye Myers: Well, thank you for your passion and your commitment. Kim, great information. Thank you so much again for joining us.
Kim Liebold: My pleasure.
Frankye Myers: We're going to wrap up. And to our listeners, if you're experiencing any of these symptoms, dizziness, fatigue, palpitation, fainting. Did I miss any? Kim?
Kim Liebold: No, no. I think those are the key ones.
Frankye Myers: Yes. Don't hesitate to reach out to your healthcare provider. Catching these issues early is so key and make a huge difference. Thank you to our listeners for tuning in. If there's a health topic you're interested in hearing more about, please email your idea to Riverside Strong dashs.com dot. Thank you.
Kim Liebold: You're most welcome. Have a blessed day.
Frankye Myers: Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
