Atrial Fibrillation

Atrial Fibrillation

Atrial fibrillation, or AFib, is a condition where the heart’s upper chamber beats irregularly, disrupting its normal rhythm, also known as sinus rhythm.

These chambers are responsible for pumping blood into the larger bottom chambers, which then distribute blood throughout your body.

In atrial fibrillation, your heart beats irregularly, and your heart does not pump blood as effectively as it should. While some individuals may experience persistent AFib, others may have episodes that come and go.

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When to Seek Medical Attention for AFib

Your health is important, and it’s essential to know when to reach out to your health care provider for assistance. Here’s what to do:

Call 9-1-1 for an Ambulance if You're Experiencing one of the Following:

  • You’re having severe trouble breathing, or you feel like you might pass out.
  • You experience symptoms of a heart attack, such as severe chest pain, sweating, or discomfort, especially if it worsens with activity like walking upstairs.
  • You notice signs of a stroke, such as numbness or weakness on one side of your body, confusion, trouble speaking or understanding, vision changes, dizziness, or severe headache without a known cause.

Call Your Doctor for Advice if:

  • You’re having difficulty breathing when talking or sitting still.
  • Your heart is racing uncontrollably and doesn’t stop after some time.
  • You’re feeling lightheaded or unusually tired.

Symptoms to Watch for:

Experiencing any of these symptoms could indicate AFib.

  • Drops in blood pressure
  • Dizziness or lightheadedness
  • Shortness of breath
  • Fatigue, weakness, and tiredness
  • Pounding or racing heart
  • Sweating or chest discomfort

Complications of AFib

  • Stroke:  AFib increases the risk of stroke as irregular heartbeats can cause blood to pool and form clots in the heart’s left atrial appendage, which can then travel to the brain.

  • Heart Attack:  AFib strains the heart muscle, potentially leading to heart failure, where the heart’s pumping efficiency declines.

  • Dementia:  AFIb is associated with cognitive decline, impacting memory, language skills, and concentration.

  • Increased Risk of Death:  AFib significantly elevates the risk of mortality, particularly if left untreated.

Testing for Atrial Fibrillation

A variety of tests and procedures may be used to diagnose and evaluate atrial fibrillation and its underlying causes. Some of the common tests and procedures include:

  • Electrocardiogram, or an ECG: An ECG is the primary diagnostic tool for detecting AFib. It records the electrical activity of the heart and can identify abnormal heart rhythms. A standard ECG provides a snapshot of the heart's rhythm at a specific moment.
  • Holter Monitor: A Holter monitor is a portable device that records the heart's electrical activity continuously over a 24- to 48-hour period (or longer). It can detect intermittent AFib episodes that may not be captured during a standard ECG.
  • Event Monitor: Similar to a Holter monitor, an event monitor is a portable device worn by the patient to record the heart's electrical activity. However, it is used for longer-term monitoring, typically for several weeks or months. Patients activate the device when they experience symptoms, allowing for the detection of AFib episodes.
  • Echocardiogram: An echocardiogram uses sound waves to create images of the heart's structure and function. It can help identify underlying structural heart diseases, such as valve abnormalities or heart failure, which may contribute to AFib.
  • Stress Test: A stress test evaluates the heart's response to physical activity or stress. It may involve exercising on a treadmill or using medications to simulate exercise if the patient is unable to exercise. Stress tests can help identify underlying coronary artery disease and assess the heart's electrical activity during exertion.
  • Blood Tests: Blood tests may be performed to evaluate the levels of certain substances in the blood, such as thyroid hormones, electrolytes, and markers of heart damage (troponin). Abnormal levels of these substances can indicate conditions that may contribute to AFib.
  • Cardiac Catheterization: Cardiac catheterization, also known as coronary angiography, involves inserting a catheter into the blood vessels to inject contrast dye and visualize the coronary arteries and heart chambers. It is primarily used to assess the presence of coronary artery disease, which can increase the risk of AFib.
  • Electrophysiology Study (EPS): An EPS is an invasive procedure used to evaluate the heart's electrical system. During an EPS, catheters are inserted into the heart to measure electrical signals and identify abnormal pathways that may be causing AFib. It can also guide treatment decisions, such as catheter ablation.

Types of Atrial Fibrillation

AFib can be classified into several types based on its duration and whether it is associated with any underlying heart conditions. The main types of AFib include:

  • Paroxysmal AFib: This occurs intermittently and spontaneously, with episodes lasting for seconds to days and then resolving on their own without any treatment. The heart typically returns to its normal rhythm between episodes.

  • Persistent AFib: Persistent AFib refers to episodes that last longer than seven days and do not resolve spontaneously. Medical intervention is often required to restore normal heart rhythm.

  • Long-standing persistent AFib: This type of AFib occurs when the abnormal heart rhythm persists for more than 12 months continuously.

  • Permanent AFib: Permanent AFib is diagnosed when the condition becomes permanent and attempts to restore normal sinus rhythm are unsuccessful or not pursued.

Atrial Fibrillation Risk Factors and Causes

Atrial fibrillation can be caused by various factors, including underlying health conditions, lifestyle factors, and genetic predispositions. Some of the common risk factors and causes of AFib include:

  • Age: AFib becomes more common in people 60 years old and older.

  • Hypertension, High Blood Pressure: High blood pressure can lead to changes in the structure of the heart, making it more susceptible to arrhythmias like AFib.

  • Heart Disease: Coronary artery disease, heart valve disease, congestive heart failure, prior heart attack, and cardiomyopathy can increase the risk of AFib.

  • Obesity: Excess weight can contribute to the development of AFib due to its association with conditions like high blood pressure, diabetes, and sleep apnea.

  • Diabetes: Diabetes is associated with an increased risk of AFib, likely due to its effects on the heart's structure and function.

  • Sleep Apnea: Sleep apnea, a condition characterized by pauses in breathing during sleep, is linked to AFib due to its impact on cardiovascular health and oxygen levels.

  • Hyperthyroidism: An overactive thyroid gland (hyperthyroidism) can increase the risk of AFib by affecting the heart's electrical system.

  • Chronic Lung Diseases: Conditions such as chronic obstructive pulmonary disease (COPD) and pulmonary embolism can increase the risk of AFib.

  • Alcohol Consumption: Heavy alcohol consumption, particularly binge drinking, is associated with an increased risk of AFib.

  • Family History: There appears to be a genetic component to AFib, with a family history of the condition increasing the risk.

  • Stress and Anxiety: Emotional stress and anxiety can trigger episodes of AFib in susceptible individuals.

  • Other Factors: Other factors that may contribute to AFib include smoking, excessive caffeine intake, certain medications (such as stimulants and some asthma medications), electrolyte imbalances, and structural abnormalities of the heart.

AFib Treatment Options

  • Blood thinners: These modifications prevent blood clots, reducing the risk of stroke.

  • Medication: Calcium channel blockers help control heart rate and rhythm.

  • Heart rhythm medication: Antiarrhythmic drugs such as flecainide, amiodarone, digoxin, and sotalol help maintain a regular heart rhythm.

  • Cardiac Ablation: Cardiac Ablation is a procedure that targets damaged tissue that causes abnormal electrical signals.

Lifestyle Changes

If you’ve had AFib in the past but currently have a normal heart rhythm, it’s essential to discuss strategies to prevent its recurrence with your doctor. This may include:

  • Controlling your blood pressure
  • Avoiding or limiting alcohol intake
  • Reducing caffeine consumption
  • Seeking treatment for an overactive thyroid gland
  • Engaging in regular exercise
  • Maintaining a healthy weight
  • Practicing stress-reduction techniques

It’s important to work closely with your health care team to develop a plan that suits your individual needs and promotes heart health.

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