Atrial Fibrillation (A-Fib)

Atrial Fibrillation (“AFib”) is a heart condition that causes an irregular and often abnormally fast heart rate. This is an electrical problem of the heart. A normal heart rate is even between 60 and 100 beats a minute at rest. During atrial fibrillation, the heart rate might be very fast and flow in the heart chambers is uneven. 2.7–6.1 million people in the US have Atrial Fibrillation.

Approximately 2% of people younger than age 65 have AFib, while about 9% of people aged 65 years or older have AFib. AFib symptoms: Some people with AFib have no symptoms at all and it is only discovered on physical examination or electrocardiogram. AFib may occur in brief episodes or may be permanent.

This can cause symptoms such as:

  • Dizziness
  • Shortness of Breath
  • Chest Pain
  • Tiredness
  • Heart Palpitations (Rapid, Pounding, Fluttering or Beating Irregularly)
  • Inability To Exercise Irregular

AFib Risks

If you have other medical problems they can cause AFib, such as:

  • High Blood Pressure
  • Atherosclerosis (Coronary Artery Disease)
  • Heart Failure
  • Heart Valve Problem
  • Chronic Kidney Disease
  • Diabetes
  • Sleep Apnea
  • Obesity

AFib increases the risk of having stroke higher by 5 times (15~ 20% of all stroke is caused by AFib, as per Heart Foundation, 2017). The major risk of AFib is a stroke. AFib can interfere with the blood flow in the heart chambers. Small blood clots can form in a heart.

A clot can travel in the blood vessels until it becomes stuck in a smaller blood vessel in the brain. Part of the blood supply to the brain may then be cut off, which causes a stroke. Sometimes people have a stroke and don’t even know that they have atrial fibrillation.

How to diagnose AFib?

AFib is diagnosed by Electrocardiogram (EKG), Holter, Event Monitor

AFib Treatments

  • Blood-thinning medication to prevent blood clots from forming and reduce stroke risk
  • Medications to control the heart’s rhythm and rate
  • Invasive procedures: Heart ablation, Maze Procedures

How can the risk of stroke be reduced?

Anticoagulants (“blood thinner”) can be used to reduce the risk of a blood clot and stroke. The treatment with anticoagulants is usually long term.

Anticoagulants reduce the risk of stroke by nearly two thirds. In other words, these treatments can prevent about 6 out of 10 strokes that would have occurred in people with AFib.

Should you take medicine to reduce your risk of stroke?

Your doctor can use a risk assessment to determine if you should take medicine to reduce your risk of stroke. Medical providers use a calculation called the CHADS2 VASc risk score to estimate the risk of stroke.

Points are added for each of the following if they apply to you:

  • Congestive heart failure with a recent exacerbation (1 point)
  • Hypertension past or present (1 points)
  • Aged 75 years or older (2 points)
  • Diabetes (1 point)
  • Past history of a Stroke or transient ischemic attack (2 points)
  • Vascular disease includes peripheral arterial disease, angina or previous heart attack (1 point)
  • Age 65-74 years (1 point)
  • Sex category (ie female sex scores 1 point and male scores 0)

FDA approved anticoagulant for AFib to reduce the risk of having a stroke:

  • Warfarin
  • Dabigatran
  • Apixaban
  • Rivaroxaban
  • Edoxaban

Warfarin can interact with some foods and other medicines. Some of the newer anticoagulants (Dabigatran, Apixaban, and Rivaroxaban) have less interaction with foods and other medicines.

If you take Warfarin you will need regular blood tests (INR tests) to check how quickly your blood clots. Dabigatran, Apixaban, and Rivaroxaban do not need regular blood tests.

Medications to control the heart’s rhythm and rate.

  • Calcium Channel Blockers.
  • Beta-blocker.
  • Antiarrhythmic Medications.

Procedures to control the heart’s rhythm and rate:

  • Cardioversion (Controlled electric shocks to the heart)
  • Heart Ablation
  • Pacemaker

 

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