CONDITIONS

What Is Atrial Fibrillation

According to the National Heart, Lung and Blood Institute (NHLBI), atrial fibrillation (AF) is the most common type of arrhythmia. An arrhythmia, also known as a dysrhythmia, is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. AF occurs if rapid, disorganized electrical signals cause the heart’s two upper chambers, called the atria, to fibrillate. The term “fibrillate” means to contract very fast and irregularly. In AF, blood pools in the atria and isn’t pumped completely into the heart’s two lower chambers, called the ventricles. As a result, the heart’s upper and lower chambers don’t work together as they should, and patients are at risk of low blood pressure, blood clots, and strokes. An estimated 2.7 million Americans are affected by atrial fibrillation.

What Causes Atrial Fibrillation

Atrial fibrillation, or AF, is an irregular and often rapid heart rate, which happens when the two upper chambers of your heart experience chaotic electrical signals. AF is closely linked with age—the older we get, the higher our chance of developing it. It is quite rare for a young patient to develop AF, unless they have an underlying cardiovascular condition. While many causes of AF are known, there are cases in which the cause is not found. Here are the most common causes of AF:

  • High blood pressure (hypertension)
  • Coronary artery disease—which is where plaque builds up inside the coronary arteries
  • Atrial flutter—similar to AF, but less pronounced. The abnormal heart rhythms are more cohesive and less chaotic than in AF. Atrial flutter can develop into atrial fibrillation
  • Congenital heart disease—which are problems with the heart or heart’s structure that one is born with, like valve or blood vessel defects. These congenital heart defects affect the normal flow of blood through the heart.
  • Mitral valve disease—where blood leaks through the mitral valve, from the left ventricle into the left atrium of the heart
  • Sleep apnea
  • Previous heart surgery
  • Cardiomyopathy—heart disease where heart muscle becomes inflamed and functions sub-optimally
  • Pericarditis—inflammation of the protective lining that surrounds the heart
  • Sleep apnea—a common disorder in which a person has one or multiple pauses in breathing while sleeping. Obstructive sleep apnea is linked to high blood pressure, which raises risk of other cardiovascular diseases.
  • Alcohol abuse—research shows a clear link between excessive consumption of alcohol and AF
  • Too much caffeine consumption—be it from coffee, soda, energy drinks or tea

Various chest infections and conditions can also increase risk of AF, like:

  • Pneumonia
  • Lung cancer
  • Emphysema
  • Chest infections
  • Pulmonary embolism
  • Carbon monoxide poisoning

Risk Factors For Atrial Fibrillation

The following are risk factors for atrial fibrillation:

  • Age. The older you are, the greater your risk of developing atrial fibrillation.
  • Heart disease. If you have heart valve problems, congenital heart disease, congestive heart failure (the failure of the heart to pump blood efficiently throughout the body) coronary artery disease (inflammation, narrowing, or damage to the arteries leading to the heart), or a history of heart attack or heart surgery, you’re at an increase risk of AF.
  • High blood pressure.
  • Certain chronic conditions such as such as thyroid problems, sleep apnea, diabetes, chronic kidney disease, lung disease or metabolic syndrome (a collection of symptoms that include excess body fat around the waist and high levels of blood sugar, cholesterol and blood pressure.
  • Drinking alcohol. For some people, drinking alcohol can trigger AF. Binge drinking may put you at an even higher risk. The federal Centers for Disease Control (CDC) defines binge drinking as the consumption of five or more drinks (for men) and four or more drinks (for women) in two hours. The National Institute on Alcoholism and Alcohol Abuse says women are more vulnerable to the effects of alcohol because they have less body water than men of similar weight, and so they absorb alcohol faster.
  • Obesity.
  • Family history.

Diagnosing Atrial Fibrillation

Diagnosis of AF usually begins with your physician’s review of your signs and symptoms, as well as your medical history. He or she will also conduct a physical exam. There are several diagnostic tests available:

  • Electrocardiogram (ECG). An ECG uses small sensors (electrodes) attached to your chest and arms to record electrical signals as they travel through your heart. According to the National Heart, Blood and Lung Institute (NHLBI), the electrical signals originate in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium, the upper right chamber of the heart. In a normal adult heart at rest, the SA node sends an electrical signal to begin a heartbeat 60 to 100 times a minute.
  • Holter monitor. This portable ECG device is carried in your pocket or worn on a belt or shoulder strap. It records your heart’s rhythms for 24 hours.
  • Event recorder. This portable ECG device is intended to monitor your heart activity over a few weeks to a few months. You activate it only when you experience symptoms.
  • Echocardiogram. Sound waves are used to produce a video image of your heart.
  • Blood tests. These help your doctor rule out thyroid problems or other substances in your blood that may lead to AF.
  • Chest X-ray. This can help your doctor see the condition of your lungs and heart.

Symptoms of Atrial Fibrillation

AF may occur without symptoms, however, some people with AF experience one or more of the following symptoms:

  • General fatigue
  • Rapid and irregular heartbeat
  • Fluttering or “thumping” in the chest
  • Dizziness
  • Shortness of breath and anxiety
  • Weakness
  • Faintness or confusion
  • Fatigue when exercising
  • Sweating
  • Chest pain or pressure (This is an emergency. Call 911)

Prognosis

Treatment can control AF. However, this condition tends to return, often getting worse when it does. It may return even with treatment. Because blood flow is interrupted and may become stagnant in a fibrillating atrium, there is increased risk of clot formation. Clots can then break off and travel to the brain can cause a stroke.

Living With Atrial Fibrillation

No matter what is causing your heart’s health to be compromised, there are things you can do to improve it:

  • Stop smoking. An estimated 20% of all deaths due to heart disease are directly linked to smoking.
  • Keep your blood pressure and cholesterol under control. People with high blood pressure and cholesterol are at an elevated risk for heart disease. About 50% of ischaemic strokes (caused by a blockage of the artery to the brain) are caused by high blood pressure.
  • Manage your weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for coronary artery disease (CAD) at a given age.
  • Engage in regular cardiovascular exercise. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack. Speak with your doctor about the right routine for you.
  • If you have diabetes, keep your blood sugar levels under control. People with diabetes are twice as likely to have a heart attack or stroke.
  • Eat a healthy diet. Opt for high fiber foods such as fruits, vegetables, and whole grains, as well as omega-3 oils such as coldwater fish and salmon), and mono- and polyunsaturated fats. But limit saturated fats and avoid trans fats, often found in fried foods, processed foods, and commercial baked goods.
  • Limit salt. The American Heart Association recently reduced the amount of salt recommended for everyone to just 1,500 mg a day, which is about two-thirds of a teaspoon.
  • Control stress.
  • Tame alcohol intake. There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Educate yourself about your condition so that you can know as much as you can about heart disease. This will help ensure you are getting the best treatment available, as well as train you to recognize any potentially harmful side effects or disease progression.

Screening

Most heart diseases and risk factors contributing to heart diseases are screened for at regular physicals. The American Heart Association stresses the importance of regular screening for cardiovascular disease. American heart association volunteer and director of William Beaumont Hospital in Royal Oak, Michigan, Barry A. Franklin, Ph. D., said on the matter, “Regular cardiovascular screening is important because it helps you detect risk factors in their earliest stages. This way, you can treat the risk factor with lifestyle changes and pharmacotherapies, if appropriate, before it ultimately leads to the development of cardiovascular disease.”

Your doctor will most likely check the following:

  • Blood pressure. High blood pressure is one of the most common precursors to cardiovascular disease. If it is found early, appropriate medications can help reduce the risk of cardiovascular disease due to high blood pressure
  • Body mass index (BMI). A BMI of 25 or above is considered to be overweight, and a BMI above 30 indicates obesity.
  • Waist circumference. A large waist circumference is indicative of fat accumulation around the midsection, which significantly raises an individual’s risk of heart disease.
  • Diet. Your doctor will most likely ask you about your diet. If your diet is high in red meats, fats, and processed foods, he or she will most likely recommend a change to include more whole grains, fatty fish, and vegetables. A diet high in red meat, fats, and processed foods can cause high cholesterol and eventually atherosclerosis (hardening of the arteries).
  • Exercise. Your doctor will ask about your exercise regimen and may suggest more or less activity based on the limitations of your heart and body.
  • Smoking and drug use. Your doctor will ask about smoking and drug use, which can add significantly to the risk of heart disease. If you do smoke or use drugs, your doctor will be able to help you find the right pathway to quit.
  • Heart rate/heartbeat. Your doctor will conduct a physical exam, listening to your heart beat and taking your heart rate. Some doctors may wish to perform a regular electrocardiogram (ECG), which can help detect irregularities in the heart’s electrical activity. ECGs are recommended.

If your doctor suspects you have a heart disease after a thorough examination, he or she may conduct several diagnostic tests to arrive at a diagnosis.

Prevention

For healthy people, the following steps have been shown to help prevent or reduce the risk factors for heart disease. Keep in mind that reducing one risk factor may help reduce others:

  • Quit smoking. An estimated 20% of deaths due to heart disease in the United States are linked directly to smoking.
  • Reduce your blood cholesterol. For every 1 percent reduction in high blood cholesterol, there’s a 2 to 3 percent decline in the risk of heart attack.
  • Avoid or control hypertension. For every one-point reduction in diastolic blood pressure, there’s a 2 to 3 percent decline in the risk of heart attack.
  • Stay active. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack.
  • Maintain a healthy weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for CAD at a given age. Obesity also increases the risk for hypertension, and high blood cholesterol.
  • Avoid or control diabetes. Type 2 diabetes (non-insulin-dependent), is an important risk factor for heart disease. According to the American Heart Association, heart disease and stroke are the number one cause of death for patients with type 2 diabetes, and adults with type 2 diabetes are two to four times more likely to have heart disease than those who do not.
  • Consider a drink a day There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Take low-dose aspirin. The recommended regimen–a baby aspirin (81 milligrams) daily or half a regular aspirin (160 milligrams) very other day–can lower the risk of heart attack by about one-third by reducing the ability of platelets in the blood to stick together and thus form a clot. Aspirin can have side effects and isn’t right for everyone, so consult with your doctor.

Medication And Treatment

Medications for AF include anticoagulants, antiplatelets, rate controllers, and rhythm controllers.


Anticoagulants                                                                                                                                                                                       Anticoagulants work by interfering with proteins involved in the clotting process, and are given to patients to prevent blood clot formation or to treat an existing blood clot. These include:

  • Aspirin
  • Warfarin (Coumadin)
  • Dabigitran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis).

 Side effects of anticoagulants include:

  • Nausea
  • Frequent nosebleeds
  • Headaches
  • Back pain
  • Easy bruising
  • Increased menstrual bleeding
  • Hair loss
  • Diarrhea

*** Because anticoagulants lengthen the time required to form a blood clot, patients taking anticoagulants are at a higher risk for excessive bleeding . Speak to your doctor about the risks and benefits of taking anticoagulants. It is especially important to take into consideration this potentially life threatening side effect.


Antiplatelet                                                                                                                                                                                       Antiplatelet medications work by stopping platelet cells from sticking together to form blood clots.

  • Aspirin
  • Clopidogrel (plavix)

Side effects of antiplatelet medications include:

  • Nausea
  • Diarrhea
  • Rash
  • Excessive bleeding

Heart-rate controlling medications                                                                                                                                                  These are drugs include beta blockers and are used to slow the heart rate. Most people can function and feel better if their heart rate is controlled. Beta blockers include:

  • Acebutolol (Sectral)
  • Propranolol (Inderal)
  • Atenolol (Tenormin)
  • Bisoprolol (Zebeta)
  • Metroprolol (Lopressor)
  • Nadolol (Corgard)
  • Timolol (Biocadren)
  • Sotalol (Betapace)

Side effects of heart rate controlling medications include:

  • Nausea
  • Stomach pain
  • Swelling in the hands or feet
  • Anxiety/Nervousness
  • Irregular heartbeat
  • Fatigue
  • Insomnia
  • Difficulty breathing
  • Loss of sex drive

Calcium channel blockers                                                                                                                                                               This class of heart medication has multiple effects on the heart. Calcium channel blockers are used to slow the heart rate in patients with AF and to reduce the strength of the muscle cell’s contraction. Some calcium channel blockers include:

  • Amlodipine (Norvasc)
  • Diltiazem (Cardizem, Tiazac)
  • Felodipine (Plendil)
  • Isradipine (DynaCirc)
  • Nicardipine (Cardene SR)
  • Nifedipine (Adalat, Procardia)
  • Nisoldipine (Sular)
  • Verapamil (Calan, Verelan, Covera-HS)
  • Amlodipine (Norvasc)
  • Diltiazem (Cardizem, Tiazac)

Side effects of calcium channel blockers include:

  • Nausea
  • Constipation
  • Headache
  • Rash
  • Edema (swelling of the legs with fluid)
  • Low blood pressure
  • Drowsiness
  • Dizziness

Digoxin                                                                                                                                                                                                        This medication slows the rate at which electrical currents are conducted from the atria, the heart’s upper cavities, to the ventricles, the heart’s two main chambers.

Side effects of digoxin include:

  • Nausea
  • Headache
  • Dizziness
  • Vomiting/diarrhea
  • Breast enlargement in men

Complementary and Alternative Treatment

The following list of supplements is offered by the University of Maryland Medical Center—always check with your cardiologist or primary doctor before adding supplements to your regimen for treating and preventing heart failure. Many people with heart conditions take multiple medications, including blood-thinning medications, blood pressure medications, and others. The supplements below may interact with these (and other medications) and may not be right for people with certain medical conditions.

  • Magnesium is particularly important for maintaining a normal heart rhythm and is often used by physicians to treat irregular heartbeat (arrhythmia). People with heart failure are often at risk for developing an arrhythmia. In addition, some diuretics (water pills) may cause your body to lose too much magnesium.
  • Carnitine. Early studies show L-carnitine supplements may reduce your chances of developing heart failure after a heart attack and improve exercise capacity if you already have heart failure.
  • Coenzyme Q-10. Several research studies suggest that CoQ10 supplements can help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and increase exercise capacity in people with heart failure.
  • Creatine is a naturally occurring amino acid (protein building block) found mainly in muscles. In a few studies of people with heart failure, injections of creatine (in addition to standard medical care) provided improvement in heart function and ability to exercise compared to those who received placebo.
  • Vitamin B1 (Thiamine may be related to heart failure in several ways. First, low levels of thiamine can contribute to the development of heart failure. On the flip side, people with severe heart failure can lose a significant amount of weight, including muscle mass (called cachexia), and become deficient in many nutrients, including thiamine. In addition, diuretics (water pills) can cause your body to lose too much thiamine..
  • Amino acids. A few small studies suggest these amino acids might be helpful for heart failure, but more research is needed:
    • Arginine (needed for the body to make nitric oxide, which helps blood flow)
    • Taurine (helps heart muscle contract)

Stress reduction practices. Since stress is associated with heart disease, it’s prudent to try techniques to help reduce it. The following methods have been shown to reduce stress in some people:

  • Meditation
  • Yoga, Tai’ Chi, and other forms of moderate exercise such as walking
  • Deep breathing
  • Visualization
  • Biofeedback

Care Guide

Being diagnosed with heart disease can be difficult for you and your family, but there are things you can do to make your life easier and healthier.

  • If you smoke, quit. Tobacco has direct and damaging effects on the cardiovascular system.
  • Avoid salt. Sodium promotes fluid retention. Avoid high-sodium foods, heavily processed foods and unnecessary salt.
  • Don’t forget to take your prescribed medications. Wearing a watch with an alarm, setting your smart phone alert, or keeping a labeled pill box on your dining table are helpful methods to remember.
  • Check other meds for potential side effects and interactions. Over-the-counter NSAIDS, such as aspirin, Motrin (ibuprofen) and Aleve (Naproxen) may increase fluid retention. Tell your doctor about any remedies you are taking.
  • Control risk factors. Work with your doctor to address high blood pressure, diabetes and atherosclerosis or other heart problems.
  • Reduce stress. The hormones released by the body in response to stress, anxiety and depression make the heart work harder. Practice relaxation techniques, volunteer, and seek positive social interactions. The relaxing breath exercise can improve the oxygenation of blood and take workload off the heart.
  • Be open with your family and friends about your condition and consider joining a support group or on-line forum.

When To Contact A Doctor

If you are being treated for atrial fibrillation, call your doctor if:

  • Are still experiencing an irregular heart rate
  • Feel heart palpitations
  • Have periods of unexplained lightheadedness, dizziness, or confusion.
  • Experience an episode of fainting, or you come close to fainting for no apparent reason
  • Have shortness of breath that gets worse with exercise

Call your doctor right away if you are taking blood thinning medication for AF and you have:

  • New bruises or blood spots under your skin.
  • A nosebleed that doesn’t stop quickly.
  • Bleeding gums when you brush your teeth.
  • Blood in your urine.
  • Black and tar like stools or they have streaks of blood
  • Heavy period bleeding or vaginal bleeding when you are not having your period

Questions For Your Doctor

In addition to your primary care physician, you may want to include a cardiologist (heart specialist), and/or an electrophysiologist (a cardiologist that specialized in arrhythmias).

Questions For A Doctor

You will probably have different questions to ask your doctor depending on your heart condition. Be open about all your concerns. If you’re having difficulty focusing, bring along a friend or family member. Below you’ll find general questions you might want to ask your doctor about heart disease as suggested by the American Heart Association.

QUESTIONS ABOUT MEDICATION

  • What is the name of the medicine?
  • Is this the brand or generic name?
  • What is the medicine supposed to do?
  • What happens if I miss a dose of my medicine?
  • How will I know that my medication is working?
  • What are the risks of taking this medication?
  • What are the risks of NOT taking this medication?

QUESTIONS ABOUT DIET

  • What kinds of foods should I eat?
  • What kinds of foods should I avoid?
  • Should I restrict my calories or fat intake to a certain level?
  • What are some cooking tips that I should follow?
  • What do I need to know about eating out?
  • Do I need to see a nutritionist or dietitian?
  • Are there any groups in the community that can help me with my nutrition goals?
  • How can I control the portions? How much salt may I eat?

QUESTIONS ABOUT EXERCISE

  • Can I exercise?
  • Can I play sports?
  • What are the best types of activities for me?
  • How much activity do I need?
  • Can I have sex?

Resources