Atrial fibrillation symptoms, causes, diagnosis and treatment guidance.

Overview

What is atrial fibrillation (AF) or irregular heartbeat?

• Atrial fibrillation (AF) is a condition where the heart beats irregularly and sometimes very fast
• The upper and lower chambers of the heart may not work together properly
• As a result, the heart may not pump blood properly to the body
• Blood can collect inside the heart and form clots
• If a clot travels to the brain, it can block blood flow and cause a stroke

What causes atrial fibrillation?

AF happens when the electrical signals controlling the heartbeat become irregular.

Common causes include:

• High blood pressure
• Prior heart attack or heart disease
• Prior heart surgery
• Diabetes
• Sleep issues
• Stress
• Caffeine
• Excessive alcohol
• Smoking
• Ageing

What are the greatest risks of AF?

• The biggest risk of AFib is a stroke
• People with AF are up to 5 times more likely to have a stroke than people without it
• AF can also weaken the heart over time and may lead to heart failure

Signs and symptoms

Common symptoms of AF include:

• Extreme tiredness or fatigue
• Shortness of breath, especially during activity or while lying down
• Chest discomfort or chest pain
• Dizziness or fainting
• Fast, pounding, fluttering or skipped heartbeats (palpitations)

Certain people may not have any visible symptoms of AF.

Tests to diagnose AF

Some of the tests used to diagnose AF include:

• Electrocardiogram (ECG/EKG): records the heart's electrical activity and is the main test for AF
• Blood tests: Check for causes such as thyroid problems or abnormal potassium levels
• Echocardiogram (heart ultrasound scan): Shows how well the heart is pumping and checks for valve problems or blood clots
• Holter monitor: A portable ECG worn for days to detect irregular heart rhythms.
• Event monitor: Records heart rhythm during symptoms such as palpitations or dizziness.
• Chest X-ray: Checks for heart enlargement or fluid in the lungs.
• Stress test / Exercise stress test: Checks how the heart works during exercise.
• Sleep study: Looks for interrupted breathing during sleep which can trigger AF.
• Magnetic resonance imaging (MRI): Gives detailed pictures of the heart structure

What treatments should I expect?

Atrial fibrillation is treated with lifestyle changes, medicines, procedures or a combination of these.

Lifestyle changes

Healthy lifestyle changes can help reduce AF symptoms, lower the risk of complications, and improve overall heart health. Some of them are:

• Maintaining a healthy weight
• Limiting or avoid alcohol and stimulants
• Staying physically active
• Avoiding illegal or recreational drugs
• Managing stress
• Avoiding smoking
• Eating a heart-healthy diet rich in vegetables, fruits, whole grains, low-fat dairy (milk, cheese, yoghurt), lean proteins (skin-less chicken), fish (high in omega-3 fatty acids like salmon, tuna), beans, nuts, seeds, and healthy fats such as soya oil, sunflower oil and avocado.
• Reducing salt intake

Medicines for AF

Medicines used to treat AF may:

• Prevent blood clots
• Slow the heart rate or
• Help restore a normal heart rhythm

Some of the medications are as follows:

• Beta blockers slow the heart rate and improve symptoms. They may not suit people with low blood pressure, chronic obstructive pulmonary disease (COPD-a long term lung condition that makes it hard to breathe) or a slow heartbeat
• Blood thinners reduce the risk of stroke by preventing blood clots, but they can increase the risk of bleeding
• Calcium channel blockers also slow the heart rate and may be used if beta blockers are not suitable.
• Heart rhythm medicines help control or correct an irregular heartbeat, but can sometimes cause side effects.

Your doctor may also treat conditions linked to AF, such as high blood pressure, diabetes, high cholesterol, thyroid problems or obesity.

Procedures and surgery for AF

If lifestyle changes and medicines do not control AF, the doctor may recommend a procedure or surgery like:

• Electrical cardioversion: Uses a controlled electric shock to restore a normal heart rhythm
• Catheter ablation: Destroys small areas of heart tissue causing the abnormal rhythm. Sometimes the procedure needs to be repeated.
• Pacemaker: A small device placed in the chest to help control slow or irregular heartbeats
• Left atrial appendage closure: Closes a small pouch in the heart to reduce the risk of blood clots and stroke in people who cannot take blood thinners
• Maze procedure - heart surgery that creates small scars in the heart to help restore a normal rhythm, usually done during other heart surgery.

Myths and facts

FAQs