September Is Atrial Fibrillation Awareness Month

An estimated six million Americans have a heart condition called atrial fibrillation (Afib).

“The impact that Afib has on us is something that nobody can really understand unless they’ve experienced it,” Mellanie Hills, founder of StopAfib.org says. “I was always in fear of my next episode. . . Life wasn’t normal as afib took a huge toll on the whole family emotionally, physically, and financially.”

Let’s look at afib, who gets it, its symptoms, how it’s diagnosed, its complications, treatment options, and how you can tap into prescription savings by comparing prescription prices in your neighborhood.

What is atrial fibrillation?

Atrial fibrillation or Afib is a condition in which the top part of your heart — the atria —beats in a fast and disorganized fashion. Normally, your heart’s built-in pacemaker tells the two atria to contract. A signal then continues to the ventricles of the heart, just below the atria. The ventricles drive blood to the lungs and the rest of your body.

The contraction of the atria followed a split second later by the contraction of the ventricles is disrupted with Afib. The atria contract haphazardly and out of synchrony with the ventricles. The lack of a unified effort between the atria and ventricles to move blood out of the heart means there’s about a 25% decrease in blood pumped with each heartbeat.

Signs and symptoms of atrial fibrillation

Some people are completely asymptomatic, first learning about their Afib diagnosis during a routine physical exam, after having a mini-stroke (transient ischemic attack or TIA), or after a full-blown stroke.

If you do have symptoms, they arise from both the feeling of the heartbeat and the reduced blood flow from the heart to the rest of the body, especially the brain. For those with symptoms, you may experience:

• Skipped or irregular heartbeats, palpitations
• A racing heart
• A flip-flopping sensation in your chest
• The feeling of a fluttering bird trapped in your chest
• Chest or throat pressure
• Weakness or dizziness
• Anxiety
• Breathlessness or poor exercise tolerance

Who gets atrial fibrillation?

Anyone of any age, can get Afib. In children, Afib usually accompanies structural heart problems they’re born with (congenital heart disease). For adults, several factorsincrease the risk of Afib. Typically, Afib occurs more often in people with:

• Advancing age — age can interfere with the heart’s natural pacemaker
• Heart problems such as coronary artery disease (atherosclerosis), heart attacks, high blood pressure, heart valve problems, and recent heart surgery
• Sleep apnea that causes pauses in breathing while you’re asleep
• Obesity
• An overactive thyroid gland
• Diabetes
• Kidney failure
• Drinking alcohol, especially binge drinking
• Stimulant use, smoking, or drinking too much caffeine
• A family history — Afib can be inherited
• A high level of stress

Types of atrial fibrillation

Afib is classified by the amount of time you have it:

• Occasional (paroxysmal) — this type of Afib comes and goes, lasting from several minutes to a week. This type of Afib may spontaneously go away or may be treated to return to a regular heart rhythm.
• Persistent — lasting longer than a week, this type of Afib needs treatment to resolve.
• Long-term persistent — is continuous and lasting longer than a year.
• Permanent —Afib is ongoing, requiring treatment to slow the heart and minimize the chance of stroke.

Diagnosing atrial fibrillation

If you’re having Afib symptoms or if you’re asymptomatic, but your healthcare provider notices you have a rapid and/or irregular pulse, you’ll have an electrocardiogram (ECG) performed. This is a non-invasive test that shows your heart rhythm. An ECG is diagnostic for Afib.

If this is your first episode of Afib, you may also have an ultrasound of the heart, called an echocardiogram. The echocardiogram looks for any structural abnormalities of your heart, such as leaky or malformed heart valves or holes in the interior walls of your heart. An echocardiogram also shows how well your heart is pumping blood.

The echocardiogram may detect blood clots in the atria. Blood clots can occur if the atria aren’t contracting and pushing blood into the ventricles. Blood clots that break free can cause mini- or full-blown strokes and heart attacks.

Based on your history, you may have blood tests to look for diabetes, thyroid problems, and kidney disease.

Your healthcare provider may recommend further testing for heart disease or sleep apnea based on your personal and family history or physical exam, too.

Lifestyle changes

Lifestyle changes may reduce your episodes of Afib or reduce the chance of getting Afib if you have risk factors. Healthcare providers recommend you adopt a heart-healthy diet, get to your ideal weight, and get regular exercise.

If you have Afib that comes and goes, keep a log of your Afib episodes and what provokes them. Identifying triggers, which vary from person to person, may take time to sort out. Common triggers are:

• Caffeine — although caffeine doesn’t trigger Afib in everyone
• Nicotine — same as caffeine, but quitting smoking will be beneficial to your health overall
• Alcohol — may trigger Afib by weakening the heart muscle over time; in the short term, it also causes dehydration, so it’s a double whammy
• Dehydration — drink plenty of water with exercise and on warm days
• Strenuous exercise in which your heart beats very fast for a prolonged time
• Poor sleep from any cause, but especially from sleep apnea
• Stress — stress hormones released into your bloodstream get your heart pumping. Under stress, people sometimes turn to caffeine, alcohol, or nicotine and sleep poorly, too; all of them increase your chance of Afib
• Eating a large meal may trigger Afib, but your heartbeat may spontaneously return to normal as you digest your food

In addition to identifying triggers, it’s essential to take care of your other health problems, such as high blood pressure and diabetes.

And if you suffer from daytime sleepiness, wake up tired, or have been told you snore or stop breathing while you sleep, discuss this with your healthcare provider. You may have sleep apnea, a common precipitator of Afib.

Medications used to treat atrial fibrillation

Along with lifestyle changes and treating any underlying causes of Afib, you may need several types of medications to treat your Afib.

Medicines to Slow Your Heartbeat

The first type of medication aims to slow your heart down to a normal rate so your heart muscle isn’t as stressed. Your healthcare provider may prescribe one of these medicines:

• Metoprolol (Lopressor)
• Atenolol (Tenormin)
• Nadolol (Corgard)
• Verapamil (Calan)
• Diltiazem (Cardizem)
• Digoxin (Lanoxin)

Medicines to Prevent Blood Clots

The second type of medication thins your blood, so stagnant blood in the atria doesn’t clot as easily. This type of medication helps reduce your risk of stroke:

• Warfarin (Coumadin)
• Apixaban (Eliquis)
• Dabigatran (Pradaxa)
• Edoxaban (Savaysa)
• Rivaroxaban (Xarelto)
• Or less commonly, aspirin

Warfarin requires routine blood tests to check how thin your blood is and limits some of your food choices. The direct-acting oral anticoagulants above (ending in “ban” or “tran”) are expensive but may be better tolerated without frequent blood testing or dietary restrictions.

Medicines for Heart Rhythm

Finally, the third type of medication serves to get your heart back into a normal rhythm and keep it there. Medications include:

• Amiodarone (Cordarone, Pacerone)
• Sotalol (Betapace)
• Dofetilide (Tikosyn)
• Flecainide (Tambocor)
• Propafenone (Rythmol)
• Quinidine

Easing the financial burden of long-term medications

The costs associated with Afib add up. “We tend to be the frequent fliers of the emergency room at the hospital, with huge medical bills and copays,” Hills says. “People can lose their jobs, their cars and houses, and some of them even their families over the impact of their AFib.”

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Procedures to treat atrial fibrillation

Not all cases of Afib can be treated with medication alone. There are common treatments, from non-invasive to invasive.

Electrical Cardioversion

With cardioversion, a small electric shock is delivered to reset your heart’s rhythm. It can be used in emergencies if you have low blood pressure, become unconscious, or are suffering from severe side effects of a rapid heartbeat. It can also be used electively to reset your heart rhythm. It is a common form of therapy.

Catheter Ablation

If you continue to have Afib, you may opt to have the abnormal pacemaker(s) blocked from sending impulses to your ventricles. The abnormal pacemaker and nerve pathways are lasered with a tiny wire by a cardiologist that specializes in heart rhythm treatment.

Maze Procedure

During a Maze procedure, a heart surgeon creates a “maze” of scar tissue with shallow cuts or burns in the atria while you are completely asleep, under general anesthesia.

Complications of atrial fibrillation

Occasionally, your heart may beat so quickly that your blood pressure drops, and your ability to get blood to your brain and heart muscle is compromised. Whether this is your first and yet-to-be-diagnosed episode or you’ve had these symptoms before, get medical help immediately.

Complications of Afib include strokes and heart attacks. A partial list of symptoms is as follows:

• Numbness or drooping of your face
• Numbness or loss of function of your arms or legs
• Difficulty speaking or confusion
• Dizziness or loss of consciousness
• Chest pressure, tightening, or pain
• Jaw pain
• Sweaty or clammy skin
• Nausea
• Shortness of breath

Afib causes about one in seven strokes. And if you have Afib, you have a five times greater risk of stroke than someone who doesn’t have Afib. Suffering from a heart attack due to Afib is much less common.

With long-standing Afib, you may experience heart failure, as the heart muscle is overworked and underfed (blood isn’t being supplied to the coronary or heart muscle arteries).

Some final messages for young people

Even if you are young, lean, fit, and otherwise healthy, don’t hesitate to seek medical attention if you’re having symptoms of Afib or a stroke. Afib may not be high on your healthcare provider’s list of medical problems if you show up in the office with palpitations or dizziness. Be sure to speak up for yourself if you think you have Afib.

Teresa Otto, MD, is a freelance medical writer on a mission to inform readers about the positive impact of good nutrition and a healthy lifestyle. She is a retired anesthesiologist who practiced in Billings, Montana, for most of her career. She graduated from the University of Washington School of Medicine in Seattle and did her anesthesia residency and fellowship at New York University and Columbia-Presbyterian in New York.

Resources:

1. https://www.stopafib.org/patient-stories/mellanie-true-hills/
2. https://www.webmd.com/heart-disease/atrial-fibrillation/features/afib-heart-personal-stories
3. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm
4. https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
5. https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/expert-answers/atrial-fibrillation-genetics/faq-20111614#:~:text=It%20has%20been%20associated%20with,a%20relative%20with%20the%20condition.
6. https://www.nhlbi.nih.gov/health/heart-healthy-living/healthy-foods
7. https://www.nhlbi.nih.gov/health/heart-healthy-living/healthy-weight
8. https://www.nhlbi.nih.gov/health/heart-healthy-living/physical-activity
9. https://healthblog.uofmhealth.org/heart-health/7-common-afib-triggers-may-surprise-you
10. https://www.heart.org/-/media/Files/Health-Topics/Answers-by-Heart/What-are-DOACs.pdf
11. https://www.healthline.com/health/dvt/warfarin-diet
12. https://www.strokeawareness.com/patient/know-the-symptoms.html?c=acv-16a37aad28a&gclid=Cj0KCQjw6_CYBhDjARIsABnuSzpiyC6kK7hnYFSo0Z7s8FWu_nCZOiMYlnF3AiHSgvbC4FYxWG7M7RcaAufkEALw_wcB&gclsrc=aw.ds

https://www.cdc.gov/heartdisease/heart_attack.htm