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I recently saw a young girl in the ER complaining of her heart beating irregularly. She was in atrial fibrillation. So I thought this would make a great article for this season. You are seeing commercials everyday about this disorder and the medicines that the pharmaceutical companies are marketing for you to choose. It is fairly common and so you should probably know a little something about it.
Most of us walk around in our everyday lives with our heart beating in what doctors like to call “normal sinus rhythm.” That means the sinus node of your heart is initiating each heartbeat as it’s supposed to. In Atrial fibrillation this is not the case as there is chaos in the heart’s electrical pathways causing it to beat irregularly.
A-fib can occur in episodes that come and go or it can be more persistent or it can be permanent. It affects between 3 and 6 million Americans and is the most common dangerous arrhythmia in the heart.
The cause of A-fib is an aberrant electrical stimulus to the heart. Normally the heart has a smooth flow of electrical current that starts in the upper two chambers, atria, and moves into the lower two chambers, ventricles, so that blood is efficiently moved from the heart through the body. In atrial fibrillation the abnormal electrical impulse moves chaotically through the upper chambers of the heart producing a “quiver” or fibrillation of the muscle that does not contract in unison so blood is not squeezed into the lower chambers of the heart. There is blood left behind in the atria, which can pool and eventually form clots. The ventricles are still working normally but as they aren’t getting their usual load of blood from the atria, the heart isn’t efficiently moving blood through the body and thus it is in a continual state of stress.
How do you know if you’re in A-fib? You will likely experience a sensation of irregular beats, light headed or dizziness, fatigue, shortness of breath or chest pain. If you feel these symptoms and you go to your doctor, as you should, an EKG will be performed which will show that your heart is in atrial fibrillation. Your doctor will also probably want some blood tests too, a chest X-ray and possibly an echocardiogram (ultrasound of the heart). If your A-fib is coming and going it may not be present when you see your doctor so they might order a Holter monitor, which you wear for a day or two to detect it.
Screening for this disorder is difficult. There are no blood tests. You either have it or you don’t and an EKG is the test you use to prove it. Currently the Apple watch can actually detect your heart rhythm and could alert you if your heart develops an arrhythmia.
Risk factors for A-fib: age (esp over 65), white males, family history (genes), obesity, drugs (i.e. cocaine), smoking, being an extreme athlete, stress, diabetes, hypertension, COPD, sleep apnea, thyroid disease, medicines (cold and flu meds like pseudophed), heart attacks and drinking alcohol in excess. Binge drinking during the holidays can cause A-fib which is why it gets called Holiday heart.
What can you do to prevent A-fib? Live a healthy lifestyle. Eat healthy, exercise regularly, avoid stress – try not to laugh at that one – and don’t use stimulants. That means no drinking energy drinks. Do eat fish with omega 3 fatty acids, fruits, veggies and oatmeal. Don’t eat foods high in trans fats, sodium, sugar and if you’re sensitive to wheat, avoid gluten.
So what is the big deal with A-fib? Why is it so dangerous? The answer is blood clots or strokes. If a clot forms in your heart because the blood is pooling then you run the risk of that clot breaking off and shooting up to your brain causing a stroke – and nobody wants that.
If you have A-fib there are several treatment options. If your heart rate is fast, beating over 100 beats per minute, then first thing to do is slow it down with medicines. Sometimes you will need IV medicines to start but then you will go home on oral medicines that will likely be for life. Beta blockers and calcium channel blockers are the most commonly used medicines to control your heart rate and rhythm. Sometimes they are given in the hospital in an IV to force your heart back into a normal rhythm. Digitalis is an older medicine that was once the gold standard but the newer medicines have largely replaced it as it has lots of side effects.
Due to the clot risk you will need to be placed on blood thinners. The classic blood thinner is Coumadin, but it requires weekly blood tests for monitoring. Newer medicines like Xarelto and Eliquis don’t require regular blood tests but are quite expensive. There is a good chance you’re going to be on blood thinners for life too.
If you’re a candidate for surgery your A-fib might be fixed for good with a procedure like an ablation or the MAZE procedure, which cuts off or destroys the heart tissue that is causing the aberrant electrical signals.
If you feel a tickle in your heart don’t ignore it. Get yourself checked out and feel better,
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
