Atrial fibrillation is probably a diagnosis you have heard of, if not because a friend or family member has it, because it has been mentioned in a public advertisement or pharmaceutical commercial. Atrial fibrillation (or “-fib”) is the most common cardiac arrhythmia, a condition estimated by the American Heart Association to be present in more than five million Americans.
A-fib happens when abnormal electrical signals occurring throughout the cardiac atria (upper chambers of the heart) override the normal intrinsic electrical pacemaker. Sometimes this causes symptoms such as heart palpitations, dizziness, poor exercise tolerance, or heart failure. In many cases, however, patients have no symptoms at all. I can recall numerous instances of finding A-fib in a patient simply by listening to their heart on a routine exam and finding the heart rhythm to be irregular. The widespread use of smartwatches and other monitoring devices is alerting people to the possibility of A-fib with greater frequency.
Atrial fibrillation is diagnosed by an electrocardiogram (ECG) or a longer term heart rhythm monitor. When we find A-fib, we should look for any underlying causes such as heart valve problems, heart failure, and even thyroid disease. More frequently, A-fib does not have any single cause; it can occur for no particular reason, but a persons risk of it increases with numerous factors including obesity, heavy alcohol use, high blood pressure, sleep apnea, and of course advancing age.
Treatment of atrial fibrillation has various options, which include medication to keep the heart from going too fast, medication to keep the heart in a normal rhythm, shocking the heart back into normal rhythm, or a catheter procedure to ablate the abnormally-firing portions of the cardiac tissue.
Of utmost importance, because in A-fib the atrial chambers do not effectively pump and empty blood into the lower chambers with each heartbeat, blood pools in some areas and has the risk of forming clots. This is why patients with atrial fibrillation are at elevated risk of a stroke and why for many of those patients we recommend taking a blood thinner long-term. We have tools to estimate stroke risk in an individual patient, so the discussion of blood thinners is one you should have with your primary care provider or cardiologist.
In summary, atrial fibrillation is a very common diagnosis, especially as patients get older. Our individualized approach to treatment focuses on control of symptoms and quality of life as well as reducing the risk of stroke.
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM on streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.
