Atrial Fibrillation

Atrial Fibrillation (AFIB)

Life is filled with many complicated situations. We are faced with situations that we would never imagine. However, we seem to never be prepared for worse case scenarios. Which was the case, within the last two weeks my family has been through turmoil. One situation we are facing is a family member dealing with AFib, which is what I would like to explain to others. We have heard of it multiple times but we never really know how to deal with it till we are faced with it.

The intention for spreading this information is to help others know they aren’t facing health issues or any other issues alone. We are not alone even when it feels like our whole world is crumbling before us. So, lets get started. Overall, I’m hoping explaining this will help myself cope with all that is going on. AFIB is a scary situation to be in. Knowing that a stroke could happen at any moment. So please enjoy this knowledgeable journey with me.

What is atrial fibrillation:

Atrial fibrillation may have no symptoms, but when symptoms do appear, they include palpitations, shortness of breath, and fatigue. Leading down a dark path of destruction when it isn’t treated. Atrial fibrillation can cause a stroke. How you may ask; well during a normal heartbeat, the upper chambers, and lower chambers of the heart work together to pump blood to the rest of the body. AFIB occurs when the upper chambers of the heartbeat irregularly, and do not pump all of the blood to the lower chambers, causing some blood to pool and potentially form clots. If a clot breaks, it can travel through the bloodstream to the brain and lead to a stroke. Although strokes related to AFIB are often more severe compared to strokes with other underlying causes just remember that anything else could cause a stroke as well.

Common facts:

• More than 200,000 U.S. cases per year

• Treatable by a medical professional

• Requires a medical diagnosis

• Lab tests or imaging often required

• Chronic: can last for years or be lifelong

• Estimated that 12.1 million people in the United States will have AFIB by 2030

• 2018 AFIB was mentioned on 175,326 death certificates and was an underlying cause of death in 25,845 of those deaths

• People of European descent are more likely to have AFIB than African Americans

• Due to the number of AFIB cases increases with age and women generally live longer than men, more women than men experience AFIB

Atrial fibrillation isn’t usually life-threatening or considered serious in people who are otherwise healthy. However, atrial fibrillation can be dangerous if you have diabetes, high blood pressure or other disease of the heart. Either way, this condition needs to be properly diagnosed and managed by a doctor.

Symptoms:

Symptoms can vary. Talk to your doctor if you experience any of these: irregular heartbeat, heart palpitations, chest pain, shortness of breath, fatigue, and light-headedness. When it comes to these symptoms, there is no time to wait. Seeking medical attention early may help reduce the chance of AFIB leading to something more serious. If you are experiencing any of these symptoms, talk to your doctor by phone, online or in person. Symptoms can also be associated with other potentially serious conditions not related to AFIB. In order to find out only a healthcare provider can determine if these symptoms indicated AFIB or another condition. Symptoms may come and go but that isn’t a reason to not play it safe and have it checked out. Even the slightest complication can lead to something major in the end when left untreated.

Diagnosis:

Is combined with multiple tests such as:

• Holter monitor: this potable ECG device is carried in your pocket or worn on a belt or shoulder strap. It records your heart’s activity for 24 hours or longer, which provides your doctor with prolonged look at your heart rhythms.

• Event recorder: this portable ECG device is intended to monitor your heart activity over a few weeks to a few months. When you experience symptoms of a fast heart rate, you push a button, and an ECG strip of the preceding few minutes and following few minutes is recorded. This permits your doctor to determine your heart rhythm at the time of your symptoms.

• Echocardiogram: this test uses sound waves to create moving pictures of your heart. Usually, a wand like device is held on your chest. Sometimes, a flexible tube with the transducer is guided down your throat through to your esophagus. Your doctor may use it to diagnose structural heart disease or blood clots in the heart.

• Blood tests: these help your doctor rule out thyroid problems or other substances in your blood that may lead to AFIB.

• Stress test: known also as exercise testing, stress testing involves running tests on your heart while you’re exercising.

• Chest X-ray: help your doctor to see the condition of your heart and lungs. Your doctor can also use an x-ray to diagnose conditions other than AFIB that may explain your signs and symptoms

Related to Stroke, but how?

AFIB increases a person’s chances for a stroke. When standard stroke risk factors were accounted for, AFIB was associated with a four-to-fivefold increased risk of ischemic stroke. AFIB causes about 1 in 7 strokes. Strokes caused by a complication from AFIB tend to be more severe than strokes with other underlying conditions. Strokes happen when blood flow to the brain is blocked by a blood clot or fatty deposits called plaque in the blood vessel lining.

Risk factors/Consequences:

• Person age 65 or older

• High blood pressure

• Diabetes

• Sleep apnea

• Heavy alcohol use

• Heart disease such as congestive heart failure and coronary artery disease

• Prior heart attacks

• Smoking

• Obesity

• Overactive thyroid

• European ancestry

• Ischemic heart disease

• Hyperthyroidism

• Chronic kidney disease

• Enlargement of the chambers on the left side of the heart

Many of these risk factors are deadly. Most people already have a disease before even developing AFIB. We want to take care of our health in order to not let any other health condition lead to AFIB.

Consequences of AFIB: more than 454,000 hospitalizations with AFIB as the primary diagnosis happen each year in the United States. This condition contributes to about 158,000 deaths each year. The death rate from AFIB as the primary or a contributing cause of death has been rising for more than two decades. Even more of a reason to take care of ourselves, to exercise and watch what we eat. We don’t want to wake up one morning struggling to breathe and find out that our heart is in AFIB.

There is no actual reason for the cause of AFIB, however there are possible causes for it. Some of those causes are:

• Abnormalities or damage to the heart’s structure are the most common cause

• High blood pressure

• Heart attack

• Coronary artery disease

• Abnormal heart valves

• Heart defects you’re born with

• Overactive thyroid or other metabolic imbalance

• Exposure to stimulants such as medications, caffeine, tobacco, or alcohol

• Sick sinus syndrome: improper functioning of the heart’s natural pacemaker

• Lung diseases

• Previous heart surgery

• Viral infections

• Stress due to surgery

• Pneumonia or other illnesses and sleep apnea

However, some people who experience atrial fibrillation don’t have any heart defects or damage, a condition called lone atrial fibrillation. Which the cause is often unclear, and serious complications are rare.

Atrial fibrillation is an irregular and often rapid heart rate that occurs when the two upper chambers of your heart experience chaotic electrical signals. The result is a fast and irregular heart rhythm. The heart rate when in atrial fibrillation may range from 100-175 beats a minute. Before AFIB your heart originally is made up of four chambers, within the upper right chamber of your heart there is a group of cells called the sinus node. This rhythm is known as your heart’s natural pacemaker and is how the heart starts its normal heartbeat. A heart that isn’t in AFIB normally the signals will travel through the two upper heart chambers and then through a connecting pathway between the upper and lower chambers called the atrioventricular node. The movement of the signal causes your heart to squeeze, sending blood to your heart and body. When a heart is experiencing atrial fibrillation the signals in the upper chambers of your heart are chaotic. As a result, they quiver. The AV node, the electrical connection between the atria and the ventricles is bombarded with impulses trying to get through to the ventricles. The ventricles also beat rapidly, but not as rapidly as the atria causing the impulses to not get through. Compared to a healthy heart, being in AFIB is a feeling I’d never want to experience or wish on my worst enemy. After all this research I want to try and live a healthy lifestyle even though you can be the healthiest person around and still experience a health issue. Yearly physicals are important!

When to see a doctor:

Our health is important to us. We should be seeing a doctor at least once a year. Especially when you are feeling any symptoms related to being in AFIB. You should make an appointment with your doctor right away. From there your doctor may order an electrocardiogram to determine if the symptoms are related to atrial fibrillation or another heart disorder. If you are experiencing chest pain, then seek emergency medical assistance immediately. This could signal that you’re having a heart attack. No matter the smallest symptom remember that you can reach out to your physician and you will be given proper medical advice and instructions to move forward with finding out the problem going on with in you.

Treatment:

For all disorders, diseases, and illness we want a cure. However, it never is that simple. There are different types of treatment, ranging from medication to other interventions to try to alter the heart’s electrical system. Common treatment includes medicine to control the heart’s rhythm and rate, blood-thinning medicine to prevent blood clots from forming and reducing stroke risk, surgery, and healthy lifestyle changes. However, it will depend on the patient and how long that patient has been dealing with atrial fibrillation, how bothersome symptoms are and the underlying causes of why your heart is in AFIB.

The process for setting up a treatment plan begin with you and your physician. Together you will come up with a treatment plan that would include whether you’re able to take medications that can control your heart rhythm. In some cases, you may need a more invasive treatment, such as medical procedures using catheters or surgery.

Other types of treatment are:

• Resetting your heart’s rhythm: ideally to treat atrial fibrillation the heart rate and rhythm are reset to normal. To correct your condition doctors maybe able to reset your heart to its regular rhythm using a procedure called cardioversion, depending on the underlying cause of atrial fibrillation and how long you’ve had it

• Cardioversion: can be done in two ways- electrical: this brief procedure is when an electrical shock is delivered to your heart through paddles or patches placed on your chest. The shock stops your heart’s electrical activity for a short moment. The goal is to reset your heart’s normal rhythm. Often done in the hospital with continuous monitoring of heart rate. If your heart rhythm returns to normal, the doctor often will prescribe the same anti-arrhythmic medication or a similar one to try to prevent more spells of AFIB

• Maintaining a normal heart rhythm: after electrical cardioversion, your doctor may prescribe anti-arrhythmic medications to help prevent future episodes. Some of those may include: dofetilide, flecainide, propafenone, amiodarone, or sotalol. Like all other medications given there are side effects such as: nausea, dizziness, fatigue and rarely, they may cause ventricular arrhythmias-life threatening rhythm disturbances originating in the heart’s lower chambers. These medications may be needed indefinitely. Even with medication there is a chance of another episode appearing

• Heart rate control: may be prescribed to control how fast your heart beats are and help restore it to a normal rate. Digoxin: this medication may control the heart rate at rest, but not as well during activity. Most people need additional or alternative medications such as calcium blockers or beta blockers. Beta blockers are medications that can help to slow the heart rate at rest and during activity. They may cause side effects such as low blood pressure. Calcium channel blockers: these medicines also can control your heart rate, but may need to be avoided if you have hart failure or low blood pressure

• Catheter and surgical procedures: sometimes medications or cardioversion to control AFB doesn’t work. In those cases, your doctor may recommend a procedure to destroy the area of heart tissue that’s causing the erratic electrical signals and restore your heart to a normal rhythm. These options include:

o catheter ablation-during this procedure a doctor inserts long, thin tubes into your groin and guides them through blood vessels to your heart. The catheter’s tip produces radiofrequency energy, extreme cold or heat to destroy areas of heart tissue that are causing rapid and irregular heartbeats. Scar tissue forms, which helps signaling return to normal. Cardiac ablation may correct the arrhythmia without the need for medications or implantable devices. Your doctor may recommend this procedure if you have AFIB and an otherwise normal heart and medication has not improved your symptoms. It may also be helpful for heart failure patients who have an implanted device and cannot take or tolerate anti-arrhythmic medications.

o Maze procedure: there are several variations of this procedure. The doctor may use a scalpel, radiofrequency or extreme cold to create a pattern of scar tissue that interferes with stray electrical impulses that cause AFIB. This procedure has a high success rate, but atrial fibrillation may come back. If this happens you may need another cardiac ablation or other heart treatment. The surgical maze procedure requires open-heart surgery because of this its generally reserved for people who don’t get better with other treatments or when it can be done during a necessary heart surgery, such as coronary artery bypass surgery or heart valve repair.

o Atrioventricular node ablation: if medications or other forms of catheter ablations don’t work or cause side effects or if you’re not a good candidate for these therapies, AV node ablation may be an option. This procedure involves using a catheter to deliver radiofrequency energy to the pathway connecting the upper and lower heart chambers. The procedure destroys a small area of heart tissue, preventing abnormal signaling. However, the upper chambers of the heart will still quiver. You’ll need a pacemaker to be implanted to keep the lower chambers beating properly. You’ll need to take blood thinners after this procedure to reduce the risk of a stroke due to AFIB

• Preventing blood clots: many people with AFIB or those who are undergoing certain treatments for AFIB are at especially high risk of blood clots that can lead to a stroke. The risk is even higher if other heart diseases are present along with AFIB.

o Anticoagulants: your doctor may prescribe blood-thinning medications such as- warfarin. If prescribed make sure to carefully follow your doctor’s instructions. Warfarin is a powerful medication that may cause dangerous bleeding. You’ll need to have a regular blood tests to monitor the effects.

o Newer anticoagulants: several newer blood-thinning medications are available to prevent strokes in patients with AFIB. They are shorter acting than warfarin and usually don’t require regular blood tests or monitoring by your doctor. These medications aren’t approved for people who have mechanical heart valves

• Left atrial appendage closure: your doctor may also consider this procedure. In this procedure, doctors insert a catheter through a vein in the leg and eventually guide it to the upper left heart chamber. A device called a left atrial appendage closure device is then inserted through the catheter to close a small sac in the left atrium. This may reduce the risk of blood clots in certain people with atrial fibrillation, as many blood clots that occur in AFIB form in the left atrial appendage. Candidates for this procedure may include those who don’t have heart valve problems, who have an increased risk of blood clots and bleeding, and who aren’t able to take anticoagulants. Your doctor will evaluate you and determine if you’re a candidate

There are different options for treatment but at the end of it all there are still many people who have spells of AFIB and don’t recognize it. If that is the case, then they may need lifelong anticoagulants even after the rhythm has been restored to normal. There is no, “NORMAL”.

Atrial fibrillation can be tolerated. You can live with it for years. It can occur occasionally, be persistent, long-standing, or permanent. Depending on the patients’ heart it would depend on how long you would experience AFIB. This subject became a sore spot for me when I experienced it firsthand with a family member. You never truly know what to expect until it has happened to you. Even though I am not going through this, I still can relate to my family member who is going through it. I can now understand how to assist and guide them through AFIB. I can also take the necessary steps to get them help they would need in case of an emergency.

Each of these stages of AFIB range from minor to severe:

• Occasional AFIB: in this case it’s called paroxysmal atrial fibrillation. You may have symptoms that come and go, usually lasting for a few minutes to hours. Sometimes symptoms occur for as long as a week and episodes can happen repeatedly. Your symptoms might go away on their own or you may need treatment

• Persistent: with this type, your heart rhythm doesn’t go back to normal on its own. If you are struggling with persistent atrial fibrillation, you’ll need treatment such as an electrical shock or medications to restore your heart rhythm

• Long-standing persistent: this type is continuous and last longer than 12 months

• Permanent: in this type the abnormal heart rhythm can’t be restored. You’ll have atrial fibrillation permanently, and you’ll often require medications to control your heart rate and to prevent blood clots

You can never know what to expect especially when it comes to your heart. Your heart is a major organ that you need to make sure you are taking care of. Overall, you never truly know how long AFIB would last, but you can be reassured that your physician will do all they can to help you control it. Try to look on the brighter or positive side of this. It won’t be fun to live with but at least you are alive. Each day is a gift. We will face trials and challenging obstacles, but physicians are always working on a cure to some type of disease or illness. We can rest assure that no matter to disease or illness we can find a way to overcome. Hope you enjoyed learning about AFIB and how it is important to keep yourself as healthy as you can.

References

www.notimetowait.com/afib-explained?cid=sem_1127672

www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624

www.cdc.gov/heartdisease/atrial_fibrillation.htm

www.healthline.com/health/living-with-atrial-fibrillation