Neurologist Dr Hamidon Basri shares the basics on atrial fibrillation, how it can lead to stroke, and the preventative measures you can take.
The Gist of It
- Atrial fibrillation causes the heart to beat too fast, too slow or with an irregular rhythm.
- Atrial fibrillation can cause very serious strokes.
- Many people with atrial fibrillation have no symptoms.
- If there are symptoms, they can include: palpitations, dizziness, chest pains, breathlessness.
- Managing atrial fibrillation focuses on reducing the risk of stroke through “blood thinning” or antithrombotic medication and, secondly, by trying to restore a normal heart rate or rhythm.
What is Atrial Fibrillation?
Atrial fibrillation is the most common heart rhythm abnormality in adults worldwide, affecting over nine million people in the European Union and the United States alone. It is a problem that causes the heart to beat too fast, too slow or with an irregular rhythm. A normal heart beats between 60 to 100 times per minute, while atrial fibrillation causes the heart to beat over 140 times per minute (although it can be any speed). This malady happens when electrical signals misfire and cause the upper chambers of the heart (the atria) to contract in a fast and irregular manner (see below). This causes blood to pool in these chambers, as the irregular beats do not pump all of the blood into the heart’s lower chambers (the ventricles), which prevents the heart from pumping effectively.
How do you know if you have Atrial Fibrillation?
Many people with atrial fibrillation have no symptoms, particularly when their heart rate is not very fast. However, common symptoms include:
- chest pains
Although some people with atrial fibrillation can suffer from it on a regular basis, they may not, or only rarely, experience symptoms. If you suspect you may be AF, assess your risk with this quick online tool. You should get diagnosed as soon as possible by a doctor or nurse as the condition can cause stroke.
The older you get the higher your risk
- The risk of atrial fibrillation increases with age.
- It affects 1% of adults worldwide.
- One in four people aged 40 years or older will develop the condition.
- It isn’t very common in children.
Causes of Atrial Fibrillation
Atrial fibrillation is more common in people who have heart disease or heart-related conditions like heart failure. Whilst some cases of atrial fibrillation have no cause, conditions and lifestyle factors known to trigger atrial fibrillation are:
- high blood pressure
- diabetes mellitus
- an overactive thyroid gland
- heart failure
- drinking too much alcohol or binge drinking
Atrial Fibrillation Can Cause Stroke
Strokes happen in atrial fibrillation when pools of blood form in the heart because of the atria not contracting well. Blood sticks together in the atria and forms clots which can travel through the bloodstream and block blood flow to the brain, causing a stroke.
A stroke is the brain equivalent of a heart attack. Blood must flow to and through the brain for it to work properly. If this flow is blocked by a blood clot, the brain loses its energy supply, causing brain damage that can lead to disability or death.
- The World Health Organisation says atrial fibrillation is one of the most important risk factors for stroke.
- People with atrial fibrillation are five times more likely to have a stroke than someone without the condition.
- Up to three million people having a stroke related to atrial fibrillation each year; that’s one person every 12 seconds.
- Atrial fibrillation-related strokes tend to be more severe, disabling and fatal than other kinds of stroke.
Atrial Fibrillation Treatment Options
Managing atrial fibrillation focuses on reducing the risk of stroke through “blood thinning” or antithrombotic medication and, secondly, by trying to restore a normal heart rate or rhythm. 1. Antithrombotic treatment If you have atrial fibrillation and are at risk of stroke, you will usually be asked to take medication to thin the blood to reduce the chance of blood clots forming. This is called antithrombotic treatment and comprises antiplatelet and anticoagulant medications. 2. Anticoagulant therapy
- This is used on patients at moderate to high risk of stroke.
- Vitamin K antagonists (VKAs) such as warfarin are commonly used as anticoagulant medication.
- These VKAs are very effective with long-term use, preventing two out of three strokes in patients with atrial fibrillation.
- VKAs can be a difficult medication for people to take as they can interact with other common medications and certain types of food.
- Patients treated with VKAs need to be monitored carefully by their doctor who must make frequent adjustments to the dose to ensure treatment remains effective.
3. Antiplatelet agent aspirin These are not as effective as VKAs for stroke prevention, and are suitable for those with atrial fibrillation at low risk of stroke who cannot tolerate VKAs. 4. Rate control Rate control uses medication to help patients with atrial fibrillation who have a fast heart rate bring their heart rate back to normal. This usually improves symptoms such as dizziness. 5. Electrical cardioversion For selected patients, the doctor may offer a method called electrical cardioversion that gives the heart an electric shock to bring the rhythm of the heart back to normal. Restoration of the sinus rhythm can also be induced by pharmacological methods of cardioversion. This is called rhythm control treatment. _____
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