The occasional irregularity of your heartbeat may be more than just a one-time occurrence. It could be atrial fibrillation, a heart arrhythmia that between 2.7 and 6.1 million Americans have.
Atrial fibrilliation, or AFib, is an irregular heartbeat that comes from the top chamber of the heart, explained Ahmad Daraghmeh, MD, FACC, a cardiologist with Trinity Health. When this occurs, blood doesn’t flow as well as it should from the upper chambers (the atria) to the lower chambers (the ventricles) of the heart.
The most common symptom of AFib is irregular heartbeat or palpitations, Dr. Daraghmeh said. The heart may feel as if it is fluttering or there is a pounding in the chest. Others may feel extreme fatigue or lightheadedness, chest discomfort, shortness of breath, exercise intolerance, fainting, and blackouts.
According to the American Heart Association, people who have one or more of the following conditions are typically at a higher risk for AFib:
Advanced age. The number of adults developing AFib increases markedly with older age. (AFib in children is rare, but it can happen.) There is a “very strong association” between older age and AFib, Dr. Daraghmeh said.
High blood pressure. Longstanding, uncontrolled high blood pressure can increase your risk for AFib.
Underlying heart disease. This includes anyone with heart disease, such as valve problems, hypertrophic cardiomyopathy, acute coronary syndrome, Wolff-Parkinson-White (WPW) syndrome, and history of heart attack. Additionally, AFib is the most common complication after heart surgery.
Drinking alcohol. Binge drinking – five drinks in two hours for men, or four drinks for women – may put you at higher risk for AFib.
Family history. Having a family member with AFib increases your chances of being diagnosed.
Sleep apnea. Although sleep apnea isn’t proven to cause AFib, studies show a strong link between obstructive sleep apnea and AFib. Often, treating the apnea can improve AFib.
Athletes. AFib is common in athletes and can be triggered by a rapid heart rate called a supraventricular tachycardia (SVT).
Other chronic conditions. Others at risk are people with thyroid problems (specifically hyperthyroidism), diabetes, asthma, and other chronic medical problems.
The easiest way to diagnose AFib is through an electrocardiogram, or an EKG, which is “a simple test in the office,” Dr. Daraghmeh said. “It will show if the heart is in the regular rhythm or if it is irregular.”
At times, the EKG may show normal results, even if a patient is feeling a recurrence of an irregular heartbeat; a Holter monitor, which monitors the heart “for a couple of days” is then used to help make a diagnosis.
“The moment we confirm the diagnosis, we will be doing a set of diagnostic testing to check for the underlying causes,” Dr. Daraghmeh said. “We will do an echocardiogram, an ultrasound for the heart that will help us study the structure and function of the heart and the valves, because valvular heart disease is a major cause of AFib.”
According to Dr. Daraghmeh, AFib is not necessarily a constant health concern. It all depends on the cause. “If this is a short-lived AFib that happened one time in the patient’s life provoked my alcohol or after a major surgery, it may not come back at all,” he said.
Ultimately, there is a variable percentage of recurrence, with no guarantee of a cure for AFib. With chronic permanent AFib, a patient can “live all their life with irregular heart rhythm,” Dr. Daraghmeh said. “We aim, in these patients, to manage the pulse rate, to keep them calm and resting, and give them blood thinners to prevent stroke without aiming to convert them back to regular rhythm.”
Management for AFib has different goals:
Medications to control the heart’s rhythm and rate: “If the heart rate is going fast and the heart is racing with AFib, we use medication from a family called beta blockers or calcium channel blockers which slow down the heart,” Dr. Daraghmeh said.
Stroke prevention: Blood thinning medication can prevent blood clots from forming and reduce stroke risk. “We use a standardized clinical scoring system to evaluate the patient’s risk for developing a stroke in patients with AFib, since the quivering of the top chamber of the heart causes slow blood flow and clot formation, which may cause a stroke,” Dr. Daraghmeh said. “Based on the clinical scoring system, we determine if the patient needs blood thinner to prevent a stoke.”
Rhythm management: “The management for the rhythm, which is the main problem, can be done by a medical cardioversion called antiarrhythmia medication. Or, electrical cardioversion can be done by delivering a controlled electrical shock across the chest while the patient is sedated, which can stabilize the electricity in the heart and convert the heart to a normal regular rhythm,” Dr. Daraghmeh said.
Surgery: Surgery is the last resort for patients who are symptomatic with recurrent AFib and failed the above mentioned options, Dr. Daraghmeh said. “We refer them to a special heart doctor, an electrophysiologist, who performs an ablation procedure.”
Medication avoidance and healthy lifestyle change to manage AFib risk factors: “We ask patients to avoid all the stimulants that can precipitate or worsen the palpitations,” Dr. Daraghmeh said, adding that being “modest” with alcohol and coffee, as well as avoiding energy drinks, drugs, or other stimulants can help.
Trinity Health’s team of cardiologists includes: Mir Rauf Subla, MD; Valentine Chikwendu, MD; Ahmad Daraghmeh, MD, FACC; Samir Turk, MD; and Amanda Weidler, FNP-C. For more information or to schedule an appointment, please call 701-857-7388.