Atrial Fibrillation: Symptoms, Causes, Prevention and Treatment

Atrial fibrillation is an irregular, rapid heart rate that increases a person’s risk of heart failure, stroke, and other heart-related complications.

The heart’s two upper chambers (the atria) beat chaotically and irregularly or out of coordination with the two lower chambers (the ventricles) of the heart, during atrial fibrillation.

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Occurrences of atrial fibrillation are intermittent, or you may develop atrial fibrillation that doesn’t go away and may require treatment. Although atrial fibrillation itself usually isn’t severe, it usually requires emergency medical treatment.

Treatments for atrial fibrillation may include medications to alter the electrical system of the heart.

Symptoms Atrial fibrillation

Most people with atrial fibrillation have no symptoms and are oblivious of their condition until it’s discovered during a physical examination. Those who do have atrial fibrillation symptoms may experience signs and symptoms such as:

Atrial fibrillation may be:

  • Occasional: This is also called paroxysmal atrial fibrillation. Symptoms may be recurrent, lasting for a few minutes to hours and then stopping on their own.
  • Persistent:This occurs when your heart rhythm doesn’t go back to normal on its own. If you have persistent atrial fibrillation, you’ll need treatment such as an electrical shock or medications in order to return your heart rhythm.
  • Long-standing persistent:This type of atrial fibrillation is incessant and lasts longer than 12 months.
  • Permanent:In this type of atrial fibrillation, the abnormal heart rhythm can’t be restored. You’ll often require lifetime medications to control your heart rate.

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When to see a doctor

If you have chest pain, seek emergency medical assistance immediately. Chest pain could an indication that you’re having a heart attack. If you have any symptoms of atrial fibrillation, make an appointment with your doctor.

Causes of Atrial fibrillation

Atrial fibrillation is an irregular and often rapid heart rate that occurs when the two upper chambers of your heart (atria) experience disordered electrical signals.

Your heart is made up of four chambers: the two upper chambers (atria) and two lower chambers (ventricles). Within the upper right chamber of your heart (right atrium) is a group of cells called the sinus node which is the natural pacemaker of your heart. The sinus node produces the impulse that usually begins each heartbeat.

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Normally, the impulse travels first through the atria and then through a connecting pathway between the upper and lower chambers of your heart called the atrioventricular (AV) node. As the signal passes from the sinus node through the atria, they contract, pumping blood from your atria into the ventricles below. As the signal passes through the AV node to the ventricles, it signals the ventricles to contract, pumping blood out to your body.

In atrial fibrillation, the atria experience chaotic electrical signals. As a result, they shiver. The AV node (the electrical connection between the atria and the ventricles), is blasted with impulses trying to get through to the ventricles.

The ventricles also beat rapidly, but not as rapidly as the atria, as not all the impulses pass through. The reason is that the AV node is like a highway on-ramp — only so many vehicles can get on at one time.

The result is a fast and irregular heart rhythm. The heart rate in atrial fibrillation may range from 100 to 175 beats a minute. The normal range for a heart rate is 60 to 100 beats a minute.

Causes of Atrial fibrillation

The most common cause of atrial fibrillation are abnormalities or damage to the heart’s structure. Possible causes of atrial fibrillation include:

  • Heart attacks
  • High blood pressure
  • Stress due to pneumonia or other illnesses
  • Previous heart surgery
  • Sleep apnea
  • Coronary artery disease
  • Lung disease
  • Viral infections
  • Abnormal heart valves
  • Heart defects you’re born with (congenital)
  • An overactive thyroid gland
  • Exposure to stimulants, such as medications, caffeine, tobacco or alcohol
  • Sick sinus syndrome — improper functioning of the heart’s natural pacemaker

Atrial flutter

Atrial flutter is comparable to atrial fibrillation, but the rhythm in the atria is more organized and less chaotic than the abnormal patterns common with atrial fibrillation. Sometimes you may have atrial flutter that develops into atrial fibrillation and vice versa.

The risk factors for and the symptoms and causes of atrial flutter are similar to those of atrial fibrillation.

Risk factors

Certain factors may increase your risk of developing atrial fibrillation. These factors include heart disease, drinking alcohol, high blood pressure, family history of heart-related disease, obesity, and other chronic conditions.

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Complications

Sometimes atrial fibrillation can lead to the following complications:

  • In atrial fibrillation, the chaotic rhythm may cause blood to gather in the upper chambers (atria) of your heart and form clots. If a blood clot forms, it could dislodge from your heart and travel to your brain. There it might obstruct blood flow, leading to a stroke.

The risk of a stroke in atrial fibrillation depends on your age (you have a higher risk as you age) and on whether you have high blood pressure, diabetes, a history of heart failure or previous stroke, and other factors. Certain medications, such as blood thinners, can greatly lower your risk of a stroke or the damage to other organs caused by blood clots.

  • Heart failure.Atrial fibrillation, especially if not controlled, may weaken the heart and lead to heart failure — a condition in which your heart can’t circulate enough blood to meet your body’s needs.

Prevention

To prevent atrial fibrillation, it’s vital to maintain a heart-healthy lifestyle such as:

  • Increasing your physical activity
  • Eating a heart-healthy diet
  • Avoiding smoking
  • Limiting or avoiding caffeine and alcohol
  • Reducing stress, as intense stress and anger can cause heart rhythm problems
  • Using over-the-counter medications with caution
  • Maintaining a healthy weight

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Diagnosis

Your doctor may review your symptoms, medical history, and conduct physical exam, to diagnose atrial fibrillation. Your doctor may order several tests to diagnose your condition, including:

  • Electrocardiogram (ECG).This uses small sensors (electrodes) attached to your chest and arms to sense and record electrical signals as they travel through your heart.
  • Holter monitor:This ECG device is carried in your pocket or worn on a belt or shoulder strap. This portable device records your heart’s activity for 24 hours or longer, which provides your doctor with an extended look at your heart rhythms.
  • Event recorder:This device monitors your heart activity over a few weeks to a few months. You activate it only when you experience symptoms of a fast heart rate. When you feel symptoms, you push a button, and an ECG strip of the preceding few minutes and following few minutes is recorded.
  • Echocardiogram:This noninvasive test uses sound waves to produce a video image of your heart. Sound waves are directed at your heart from a wand-like device (transducer) that’s held on your chest (transthoracic echocardiogram). The sound waves that bounce off your heart are reflected through your chest wall and processed electronically to provide video images of your heart in motion, to detect fundamental structural heart disease.
  • Blood tests:Blood tests help your doctor rule out thyroid problems or other substances in your blood that may lead to atrial fibrillation.
  • Stress test:This involves running tests on your heart while you’re exercising.
  • Chest X-ray:X-ray images help your doctor see the condition of your lungs and heart. Your doctor can also use an X-ray to identify conditions other than atrial fibrillation that may explain your signs and symptoms.

Treatment

The treatment goals for atrial fibrillation are to:

  • Prevent blood clots
  • Decrease the risk of strokes
  • Reset the rhythm or control the rate

Resetting your heart’s rhythm

To treat atrial fibrillation, the heart rate and rhythm are reset to normal. To correct your condition, doctors may be able to reset your heart to its regular sinus rhythm using a procedure called cardioversion. You may have a test called transesophageal echocardiography which can tell your doctor if you have any heart blood clots just before cardioversion.

Cardioversion can be carried out in two ways:

  • Electrical cardioversion.An electrical shock is delivered to your heart through paddles or patches placed on your chest. The shock stops your heart’s electrical activity briefly. When your heart begins again, the hope is that it resumes its normal rhythm. The technique is performed during sedation, so you shouldn’t feel the electric shock. Your doctor may give you medications to help restore normal sinus rhythm before the procedure.
  • Cardioversion with drugs.This form of cardioversion uses medications called anti-arrhythmics to help restore normal sinus rhythm. Depending on your heart condition, your doctor may recommend trying intravenous or oral medications to return your heart to normal rhythm.

This is often done in the hospital with continuous monitoring of your heart rate. If your heart rhythm returns to normal, your doctor often will prescribe the same anti-arrhythmic medication or a similar one to try to prevent more spells of atrial fibrillation.

Before cardioversion, you may be given a blood-thinning medication such as warfarin (Coumadin, Jantoven) for several weeks to reduce the risk of blood clots and stroke.

Maintaining a normal heart rhythm

After electrical cardioversion, your doctor may prescribe anti-arrhythmic medications to help prevent future episodes of atrial fibrillation. Medications may include:

  • Dofetilide (Tikosyn)
  • Flecainide
  • Propafenone (Rythmol)
  • Amiodarone (Cordarone, Pacerone)
  • Sotalol (Betapace, Sorine)

Although these drugs may help maintain a normal heart rhythm, they can cause side effects, including fatigue, dizziness, and nausea. These medications may be needed for life.

Disclaimer: The content is purely informative and educational in nature and should not be interpreted as medical advice. Please use the content only in consultation with an appropriate certified medical doctor or healthcare professional.

 

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