Drums pounding or fish flopping in the chest are ways that people describe atrial fibrillation (AFib). During AFib Awareness Month this September, get to know the symptoms and how to best control the disease.
Affecting more than 2.5 million American adults, atrial fibrillation is the most common type of sustained irregular heartbeat (or arrhythmia). The condition causes the top chambers of the heart (atria) to flutter (fibrillate) as fast as 300 to 400 times per minute (instead of the normal 60 to 80 times a minute).
Many people, however, don’t realize that they have the condition. By recognizing the symptoms and treating AFib, patients can live longer, healthier lives.
Philip Beckley, PhD, senior atrial fibrillation clinical specialist with the Society of Cardiovascular Patient Care, reported that one study found that people over the age of 40 had a one in four chance of developing AFib in their lifetimes, and the condition was responsible for 15 to 20 percent of all reported strokes.
The Mayo Clinic states that fewer than one in every 100 people in their 50s experience AFib, but about 10 out of every 100 in their 80s have it.
Because of the abnormal beating of the heart, blood has a chance to pool and the opportunity clot. The clot can then be pumped out by the heart and travel, possibly blocking blood flow in an artery to the brain and causing a stroke.
Know the Signs
In addition to feeling a pounding or flopping sensation in the chest, signs of AFib include fatigue, lightheadedness, sweating, rapid heartbeat, palpitations, shortness of breath and even fainting, according to the American Heart Association.
Chest pain or pressure is also a serious possible indicator of AFib, and if a person experiences this, it is a medical emergency and 911 should be called immediately.
Some individuals with AFib, however, have no symptoms. For these people, it may be advisable to be checked for AFib by a healthcare provider if they have the risk factors for the condition.
Are You at Risk for AFib?
Here are six risk factors that may increase the likelihood of having AFib, according to the Mayo Clinic:
- Age. The median age for patients with atrial fibrillation is 66.8 years for men and 74.6 years for women, according to the Centers for Disease Control and Prevention (CDC).
- Heart Disease. Clogged arteries increase the likelihood of AFib.
- High Blood Pressure. Keep pressure under control to lower risk of AFib.
- Other Chronic Conditions. Thyroid problems, sleep apnea, diabetes and other medical problems may elevate the likelihood of developing AFib.
- Drinking Alcohol. Too much alcohol can be the trigger for an episode of AFib.
- Family History. The condition may run in the family.
The Heart Rhythm Society (HRS) is an organization dedicated to cardiac arrhythmia education. As part of its efforts to increase public knowledge of atrial fibrillation, HRS provides an online interactive tool on its website that allows visitors to evaluate their risk of developing AFib. To complete the AFib Risk Assessment, go to the link shown in the resources below.
If individuals think they are at high risk, they may want to get an electrocardiogram (EKG), a simple, painless test that records the heart’s activities and can detect AFib.
Preventing and Treating AFib
All the standard measures that can keep a person heart healthy can help prevent AFib as well. Those include regular exercise, eating a healthy diet (low in saturated and trans fats and cholesterol), controlling high blood pressure, avoiding excessive consumption of alcohol and caffeine, not smoking and keeping a healthy weight.
Treatments for AFib depend on the underlying cause of the arrhythmia, how long the patient has had the condition and how severe the symptoms are. Ultimately, the goal is to get the rhythm on track and prevent blood clots.
Sometimes, AFib is related to a specific condition. If hyperthyroidism is the cause, treating the thyroid condition may eliminate the AFib.
Certain procedures have proven effective in managing AFib. For example, radiofrequency catheter ablation uses radiofrequency energy (similar to a microwave) to kill off specific heart cells so they can no longer conduct extra impulses that cause AFib.
Cardioversion is also a common method for resetting a heart that is beating too fast or irregularly. It can be done as an electrical procedure, using low-energy shocks to re-establish a normal heartbeat. Medications can also be used as a form of cardioversion to correct the arrhythmia. These medications include amiodarone (Cordarone, Pacerone), dronedarone (Multaq), propafenone (Rhythmol), sotalol (Betapace), dofetilide (Tikosyn) and flecainide (Tambocor).
There are a range of other medications that can help slow the heart rate and control the rhythm with AFib. Some are called beta blockers, such as bisoprolol (brand name Zebeta), carvedilol (Coreg), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal) and timolol (Blocadren). Others are called calcium channel blockers, such as dilitiazem (Cardizem, Cartia XT, Dilacor XR, Dilt-CD, Diltzac, Taztia XT, Tiazac) and verapamil (Calan, Covera, Isoptin, Verelan).
Digoxin (Lanoxin) slows the rate at which electrical currents are conducted from the atria to the ventricle in the heart. Digoxin also increases the force with which the heart muscle contracts, making each heartbeat more efficient.
Additional medications are available, depending on the patient’s condition and healthcare provider’s diagnosis.
To prevent (or possibly treat) blood clots, AFib patients may also take blood thinners, such as aspirin, warfarin (Coumadin, Jantoven), dabigatran (Pradaxa) and rivaroxaban (Xarelto).
Registered pharmacist Jason Poquette, BPharm, RPh, told dailyRx News, “Patients may be prescribed a variety of prescription medications to treat the AFib, and each requires its own unique counseling and instructions.
"For example, digoxin is a cardiac glycoside [a class of medication] sometimes used to treat AFib or heart failure. Patients taking digoxin need to be aware that this drug has a very narrow therapeutic index (NTI). This means that blood levels even slightly too high or too low may be ineffective or dangerous,” Poquette said.
To use this medication safely patients need to take it at the same time daily, get their blood levels checked, know the potential side effects to watch out for and be aware of possible drug interactions with other medications, according to Poquette.
Ralph Sacco, MD, professor and chairman of neurology at the Miller School of Medicine at the University of Miami and past president of the American Heart Association, said in a press release that medications to treat high blood pressure and atrial fibrillation are very effective in preventing stroke as well.
“AFib is a serious condition, but can be managed effectively when well-informed patients and their healthcare providers are working together to control it with appropriate medication,” added Poquette.