A8. Atrial Fibrillation

Atrial Fibrillation

Did you know the human heart beats more than 100,000 times a day? At that pace, it’s no wonder you might feel your heart skip a beat or flutter from time to time. However, if you notice your heart suddenly races or if you have uneven heartbeats that last several minutes, you may have a condition known as atrial fibrillation.

Atrial fibrillation (also called AFib) is a problem with the rate or rhythm of the heartbeat. Your heart’s electrical system tells your heart when to contract and pump blood to the rest of your body. With AFib, these electrical signals short circuit in a sense. This results in a chaotic, rapid heart rate. You might feel short of breath, dizzy and overly tired, although not everyone has these symptoms.

If you have AFib, it’s important to remember you’re not alone. AFib affects more than 3 million Americans. If untreated, it can lead to blood clots, stroke and heart failure. In fact, people with AFib are five times more likely to have a stroke than people without the condition.

As with other heart problems, the choices you make every day can make a difference in your symptoms and general heart health. So, stay in sync with your heart and learn more. Use this condition center to learn more about atrial fibrillation. You can also chat online with other people like you, keep up with the latest research, and get tips to help you feel your best.

Overview

Under normal circumstances, the human heart pumps to a strong and steady beat—in fact, more than 100,000 heartbeats each day! But if you have atrial fibrillation, or AFib, the heart doesn’t always beat or keep pace the way it should. Many people with AFib say they can feel their heart racing, fluttering or skipping beats.

AFib is the most common heart rhythm disorder (arrhythmia). A major concern with AFib is that it also makes blood clots in the heart that can travel and cause strokes or block flow to other critical organs. In fact, people with this condition are five times more likely to have a stroke than people without the condition. It can also lead to heart failure. But finding and treating AFib early on can help you avoid these problems.

What is atrial fibrillation?

Your heart’s electrical system tells your heart when to contract and pump blood to the rest of your body. With AFib, these electrical impulses don’t work the way they should, short-circuiting in a sense. As a result, the heart beats too quickly and irregularly.

AFib is sometimes called a quivering heart. That’s because the two upper parts of the heart (called the atria) quiver. When this happens, the normal communication between the upper and lower chambers of the heart is disrupted and becomes very disorganized. Because of this, many people with AFib feel zapped of energy fairly quickly or notice being out of breath simply walking up one flight of stairs. That’s because you may not be getting enough oxygen; the heart isn’t able to squeeze enough nutrient-rich blood out to the body.

There are 3 types of AFib:

  • Paroxysmal: Comes and goes and generally stops on its own.
  • Persistent: Lasts more than a week and can become permanent.
  • Permanent: The heart’s normal rhythm can’t be restored.

Some cases of AFib are due to a heart valve problem, while some are not.

If you have AFib, you’re not alone. It’s the most common type of irregular heartbeat, affecting more than 3 million Americans. If untreated, it can lead to blood clots, stroke and heart failure.

Because your heart beat is out of sync, blood can collect in the chambers of the heart. When this happens, blood clots can form and can travel to the brain causing a stroke. Strokes related to AFib tend to be more severe and deadly.

What puts you at risk for AFib

Several factors make AFib more likely.

  • Older age, although it can happen at any age
  • Conditions that place added strain on the heart, including high blood pressure, previous heart attack, heart surgery, valve disease, or heart failure
  • Other illnesses such as obesity, sleep apnea or hyperthyroidism
  • Family history
  • Drinking too much alcohol (routinely having 3 or more drinks a day or binge drinking)

Episodes of AFib are often triggered by certain activities. These may include:

  • Heavy alcohol use
  • Too much caffeine or other stimulants
  • Periods of severe stress
    • the stress of the body fighting infection
    • the stress of recent surgery

Pay attention to what might make symptoms of AFib worse, so that you can share this information with your health care team.

How it feels

Some people with AFib don’t have any symptoms. Those who do may report:

  • Heart palpitation—a thumping or racing heart, fluttering or skipping beats
  • Feeling unusually tired or fatigued
  • Unexplained shortness of breath
  • Dizziness or fainting spells
  • Chest pain (angina)

Detecting an abnormal heart rhythm

To find out if you have AFib, your doctor will likely rely on a combination of:

  • Your medical history and physical exam
  • Results from an electrocardiogram (ECG)—a test that records your heart’s electrical activity and shows deviations
  • Other methods to monitor your heart’s rhythm, if needed. Additional tests may include:
    • Wearing a Holter monitor, essentially a portable EKG to measure and record your heart’s activity for 24 hours
    • Using an event monitorthat, with a push of a button, allows you to record what is happening when you feel symptoms such as chest pain, dizziness or palpitations. Electrodes are placed on your chest and are connected by wire leads to the recording device. You generally will wear this for 1 month.
    • Having an echocardiogram, an ultrasound that takes pictures of the heart and measures the chambers and how well it is pumping

Sometimes, people are diagnosed with AFib after going to the hospital emergency department and are “in AFib.”

Treatments

The good news is that with the right treatment, you can live a good life with AFib. But you need to be in tune with your heart and body. Untreated, atrial fibrillation can lead to blood clots, stroke and other heart-related problems, including heart failure.

Your treatment will likely depend on:

  • Your age
  • Your symptoms and the frequency of episodes
  • Whether your heart rate is under control
  • Your risk for stroke (see the CHADS2VASC score to determine your risk and need for anticoagulation)
  • Other medical conditions, including if you already have heart disease

Treatment of AFib focuses on lifestyle changes and either rate control or rhythm control. Therapies to prevent blood clots and stroke are also important.

Lifestyle changes may include:

  • Eating a heart-healthy diet full of fresh fruits and vegetables, fiber-rich foods, lean meats and fish and unsaturated fats like olive oil
  • Limiting alcohol and caffeine
  • Exercising regularly—aim to get 30 minutes of physical activity most days
  • Managing stress levels
  • Not smoking
  • Taking your medication(s) as directed and managing other conditions

In addition to lifestyle changes, treatments often include medications and/or procedures.

Medications

Medications are used to:

  • Prevent clots from forming or to dissolve an existing clot
  • Restore your heart’s rate or rhythm

Medications to prevent or treat blood clots and stroke include:

  • Aspirin
  • Blood thinners/anticoagulants such as warfarin (brand name: Coumadin, Jantoven), dabigitran (brand: Pradaxa), rivaroxaban (brand: xarelto), and apixaban (brand:Eliquis)

Talk with your doctor about which blood thinner is right for you. Keep in mind that if you take a blood thinner, you must be very cautious about falls and other accidents that might cause bleeding. There are medicines or antidotes that can reverse the blood-thinning power of warfarin, but no reversal agents exist yet for the newer medications.

There may also be dietary restrictions. For example, foods like spinach, kale and other vegetables are rich in vitamin K, which can disrupt the way warfarin works. That’s why you have to be careful to consume the same amount every day if you take warfarin. You also need to have your blood checked frequently when taking this medicine (called your INR/PT).

Rate controlling medications Heart rhythm controlling medications
· Used to slow the heart rate during AFib

· May relieve symptoms caused by a fast heart rate

· Examples include:

· Beta-blockers

· Calcium channel blockers

· Digoxin (brand: Lanoxin)

· Used to return the heart to its normal rhythm and keep AFib from returning

· May relieve symptoms caused by an irregular heart rate

· Examples of antiarrhythmic medicines

Medical procedures

  • Electrical cardioversion—uses low-voltage electrical shock applied to the chest with paddles to restore a normal rhythm
  • Catheter-based ablation—a tube is inserted into a vein in the leg and threaded to the heart to fix the faulty electrical signals
  • Surgical maze—small scar lines are made on the heart, creating a “maze” to prevent or redirect the abnormal beats from controlling the heart. This is done through open heart surgery.
  • Pacemakersor atrial defibrillators—implantable devices that help restore and maintain regular heart rhythm

Know signs of a stroke

If you live with AFib, it’s critical that you know the warning signs of stroke so that you can act fast. Call 112 right away if you have any sudden:

  • Numbness or weakness in your face, arms or leg, especially on one side of the body
  • Trouble walking or loss of balance or coordination
  • Trouble seeing out of one or both eyes
  • Confusion, trouble speaking or understanding
  • Severe headache

Be sure other people in your life are aware of these signs as well.

Did You Know?

  • A healthy heart beats between 60 and 100 times per minute. With AFib, it beats much faster—as many as 175 times per minute!
  • 1 in 5 strokes in the U.S. are due to AFib
  • Men are more likely to develop AFib, but women who have it are more likely to die earlier in life
  • Remember, many people with AFib may not have symptoms

Talking with your care team

It can be unsettling to live with AFib, especially if you can physically feel your heart beating unevenly. Be sure to share any concerns with your care team, especially how to manage your risk for stroke.

Here are some questions you may want to ask:

  1. What type of AFib do I have? Will I have it forever?
  2. What’s the difference between medications that control heart rhythm and those that control heart rate? Which one might be better for me and why?
  3. How serious is my risk for stroke?
  4. Which blood thinner is best for me?
  5. How else can I lower my risk of stroke?
  6. Are there changes I can make in my everyday life to prevent episodes of AFib?
  7. What type and how much exercise should I be getting?
  8. At what point should I consider a device or surgical procedure?
Category
Conditions