When functioning normally, the human heart beats over 100,000 times every single day. However, some medical conditions can affect the functioning of your heart and reduce the heart’s ability to pump properly.
When you have atrial fibrillation (commonly referred to AF or AFib), you might feel your heart racing, fluttering, and even skipping beats. Sometimes, this erratic heart rate can be very uncomfortable, but other patients are not particularly bothered by the palpitations. In fact, many patients do not even realize they have atrial fibrillation because they have no symptoms at all. However, this heart rhythm disturbance can lead to significant problems for your cardiovascular health. In fact, atrial fibrillation is the most common heart rhythm disorder affecting adults, and it can lead to deadly complications, including blood clots that can travel throughout the body and result in a massive, even fatal stroke.
It is an unfortunate fact that people with atrial fibrillation are five times more likely to have a stroke, so if you even suspect you might have AF you should get to the doctor’s office to be evaluated.
Diagnosing and treating atrial fibrillation as early as possible is one of the best ways to avoid long-term complications, so read this article carefully to learn what to do.
What is Atrial Fibrillation?
Atrial fibrillation is an irregular heartbeat that arises from the top chamber of the heart. An estimated 2.7 million Americans have AFib, and the condition leads to symptoms such as palpitations, which is the sensation that the heart flip-flops, skips beats, and even bangs against the walls of the chest cavity. Many patients report other symptoms such as shortness of breath, lightheadedness, weakness, and inability to exercise as much as they used to. Others don’t experience any symptoms and only discover that they have atrial fibrillation during a routine doctor visit.
In a healthy cardiovascular system, your heart contracts and relaxes at a regular rate. The contraction of the heart muscle is controlled by the heart’s electrical system, and we can analyze the electrical activity of the heart with an electrocardiogram (referred to as ECG or EKG). Atrial fibrillation is an electrical disturbance where the activity of the top chambers (the atria) becomes rapid and disorganized, which causes the atria to beat in an ineffective manner… the muscle just quivers instead of squeezing in a coordinated fashion. The rapid electrical impulses cause the heart to beat irregularly, which affects the flow of blood from your heart to the rest of your body. Because the atrial muscle is not contracting efficiently, the blood becomes slow-moving and blood clots may form in the nooks of the left atrium. If a clot breaks loose, it can then travel in the arterial circulation. Clots can wind up in the brain, leading to a stroke. Clots can also land in other parts of the body, which can damage almost any organ by blocking the flow of oxygenated blood to that region.
In fact, about one in five strokes are caused by atrial fibrillation. For this reason, patients with atrial fibrillation need to be assessed for their risk of stroke and, if necessary, be treated with a blood thinner to avoid clot formation in the heart.
Three main types of atrial fibrillation are recognized:
- Paroxysmal AF: tends to come and go and generally stops within a day or two without the use of medication
- Persistent AF: does not stop on its own – a medical procedure called cardioversion is usually necessary to restore a normal rhythm
- Permanent: persistent atrial fibrillation with no ability or plans to restore a normal rhythm
What Causes Atrial Fibrillation?
Your heart is controlled by electrical impulses that trigger it to contract and pump blood throughout the day. In atrial fibrillation, rapid, chaotic signals arise from the atria (top chambers). Atrial fibrillation is sometimes considered a consequence of the aging process of the heart but it can be accelerated by the presence of underlying heart disease and possibly genetic factors.
There are many risk factors that can trigger atrial fibrillation. Often these are due to lifestyle choices like a poor diet or too little exercise. Several other factors can put you at increased risk of developing atrial fibrillation, including the following:
- Old age
- High blood pressure
- Coronary artery disease or vascular disease
- History of prior heart attacks
- Previous heart surgery
- Congestive heart failure
- Illnesses like obesity, sleep apnea, or hyperthyroidism
- Family history of irregular heartbeats
- Drinking too much alcohol (three or more drinks a day)
- Excessive caffeine or other stimulants
- Periods of severe stress, perhaps after surgery or with a severe infection
- Certain medications including diuretics (water pills), diet pills, decongestants
If you notice the symptoms of atrial fibrillation, it’s important to pay attention to what is making them worse so that you can relay the information to your doctor.
Heart Rates with Atrial Fibrillation
Although the atria are beating extremely rapidly during atrial fibrillation, not all of those rapid impulses make their way to the bottom chambers or ventricles. The ventricular rate determines how fast your pulse goes, and the electrical connection between the chambers is what transmits the signals from the top to the bottom of the heart. This connection is referred to as the atrioventricular node or AV node. If the AV node is relatively healthy, your pulse rate may be rapid and irregular. We refer to that as having atrial fibrillation with a “rapid ventricular response” or AF with RVR.
A normal heart rate at rest usually ranges around 60-80 beats per minute. During atrial fibrillation, people with healthy AV nodes can develop heart rates of 125-175 bpm. In contrast, people with abnormally functioning AV nodes can have slower heart rates, even below 100 beats per minute. A variety of medications are used to control the rapid ventricular rate of AFib, which reduces the symptoms and can allow people to tolerate this arrhythmia more easily.
If you have AFib with RVR, you may experience a rapid, fluttering heartbeat, chest pain, shortness of breath, lightheadedness or other serious symptoms. The rapid rate affects the heart’s ability to pump efficiently. In fact, someone with severe coronary blockages who develops AF with RVR can wind up with significant heart muscle damage… a form of heart attack. If the rapid rate persists for more than a few days, the reduced efficiency of the heart function can lead to heart failure, so it’s important to seek medical attention right away if you think you have the condition. In addition, sudden rapid heart rates can cause the blood pressure to drop precipitously, and this can result in a fainting spell. Finally, if the AF lasts more than 24 hours, the risk of clot formation increases, so patients need to seek medical attention quickly to minimize their risk of a stroke.
In contrast, AFib with a moderate ventricular response (heart rates below 100 bpm) is less likely to cause symptoms and is significantly less dangerous for your cardiovascular health. However, the stroke risk remains regardless of the pulse rate, and patients need to discuss with their doctor the risks and benefits of taking a blood thinner to reduce the risk of stroke.
The only reliable way to diagnose atrial fibrillation is with an electrocardiogram or a heart monitor. Your doctor can perform an ECG test right in the office, but it typically takes at least 24 hours to get reliable results from a heart monitor. Paroxysmal atrial fibrillation, which comes and goes, may take weeks or even months to diagnose if the episodes occur infrequently. In that case long-term cardiac monitoring may be needed to confirm the diagnosis.
If you think you are at risk for atrial fibrillation, schedule an appointment with your doctor to get a better understanding of the condition and to discuss how to go about diagnosing the problem. Early detection is the key to managing AF, and reducing aggravating factors (like hypertension, diabetes, alcohol use, stress, etc.) can improve your cardiovascular system and help you live a healthy life.