A couple months ago, Vice President Dick Cheney was hospitalized for an irregular heartbeat called atrial fibrillation. This irregular heartbeat, called an arrhythmia, is a very common heart disorder. In fact, atrial fibrillation is the most common arrhythmias in the adult population, affecting more than two million Americans.
Arrhythmias are disorganized heartbeats, in which the electrical trigger for the heart muscle to contract occurs at either an inappropriate rate or rhythm. An inappropriate heart rate is when the heart beats either too fast or too slowly. An irregular rhythm is when the heart beats at an erratic and non-constant beat. Just like a metronome in music, the heart should beat at a relatively constant rate and a constant rhythm. Atrial fibrillation is a type of arrhythmia that originates in the two top chambers of the heart, appropriately called the atria, which then cause the entire heart to beat in an erratic and inefficient fashion.
So how would you know if you went into this arrhythmia? Most people who develop this arrhythmia note some subtle, yet important symptoms. They may feel slightly weak and washed out, warm and sweaty, while some note an irregular heart sensation like the heart is jumping or flipping around in their chest. If the heart beats fast enough during this arrhythmia, patients may feel dizzy and some develop chest pain. One of the easiest ways to detect this arrhythmia is to check your pulse and seek medical attention if necessary.
Interestingly, the risk factors for atrial fibrillation shadow those of coronary heart disease, specifically: older age, history of heart attacks, high blood pressure, diabetes, abnormal heart valves, long standing lung disease, and some medications or even commonly used stimulants such as caffeine and nicotine.
The good news is that atrial fibrillation is not classically life threatening. Yet, atrial fibrillation is associated with several symptoms that can greatly diminish the quality of life of those afflicted with this chronic and often debilitating condition. Atrial fibrillation can cause significant fatigue and decreased exercise capacity, and if it is present for many years it can actually cause heart failure. However, the most dreaded complication of atrial fibrillation is a stroke.
A stroke can occur when the blood in the erratically contracting atria starts to pool and allows formation of a blood clot. This clot can subsequeuntly travel forward into the brain circulation, causing a stroke. This is an all too common problem in atrial fibrillation, causing nearly 1 in 5 of all strokes and raising your rate of developing a stroke five times that of someone without atrail fibrillation.
The best way to prevent this terrible complication is to prevent blood clots from forming in the first place. This can be done with a daily aspirin for those people with low risks factors for developing a stroke, or treatment with a blood thinner called Coumadin (Warfarin) if the risk of stroke is relatively high. Coumadin is taken daily and unfortunately must be closely monitored by your physician with weekly to monthly blood samples. However cumbersome and inconvenient this may be, it is currently the best way to reduce the risk of developing a stroke.
Treatment is also focused on controlling the heart rate or restoring the heart to a normal heart rhythm. The best way to control the heart rate is with oral medications. This includes many commonly used medications, all of which control the heart rate, yet accept that the heart is still in this erratic mode of contracting. In contrast, rhythm management has the sole purpose of trying to get the heart back into regular rhythm. This too can be done with medications, yet these medications must be given by a heart doctor during very close hospital supervision. Another technique used by heart doctors to restore normal rhythm is to apply a short burst of electrical energy across the chest. This safe procedure, called cardioversion, is only performed in hospital.
Most recently a procedure has been developing in which doctors use small catheters inside the heart to burn abnormal heart tissue that triggers atrial fibrillation. This technique, called ablation, is only performed at specialized heart centers. Once successful, the heart is unable to go back into atrial fibrillation because of the absence of triggers.
In the end, atrial fibrillation is a very common and possibly debilitating heart condition. Appropriate management includes identification of the arrhythmia, immediately control the heart rate and rhythm, and ultimately how best to reduce the risk of stroke. Although not truly life threatening, close management by a heart specialist can greatly improve the overall qualitative life of patients with atrial fibrillation.
David M. Donaldson, MD, is an Auburn native and currently a cardiologist at Massachusetts General Hospital in Boston.
So how would you know if you went into this arrhythmia? Most people who develop this arrhythmia note some subtle, yet important symptoms. They may feel slightly weak and washed out, warm and sweaty, while some note an irregular heart sensation like the heart is jumping or flipping around in their chest. If the heart beats fast enough during this arrhythmia, patients may feel dizzy and some develop chest pain. One of the easiest ways to detect this arrhythmia is to check your pulse and seek medical attention if necessary.
Interestingly, the risk factors for atrial fibrillation shadow those of coronary heart disease, specifically: older age, history of heart attacks, high blood pressure, diabetes, abnormal heart valves, long standing lung disease, and some medications or even commonly used stimulants such as caffeine and nicotine.
The good news is that atrial fibrillation is not classically life threatening. Yet, atrial fibrillation is associated with several symptoms that can greatly diminish the quality of life of those afflicted with this chronic and often debilitating condition. Atrial fibrillation can cause significant fatigue and decreased exercise capacity, and if it is present for many years it can actually cause heart failure. However, the most dreaded complication of atrial fibrillation is a stroke.
A stroke can occur when the blood in the erratically contracting atria starts to pool and allows formation of a blood clot. This clot can subsequeuntly travel forward into the brain circulation, causing a stroke. This is an all too common problem in atrial fibrillation, causing nearly 1 in 5 of all strokes and raising your rate of developing a stroke five times that of someone without atrail fibrillation.
The best way to prevent this terrible complication is to prevent blood clots from forming in the first place. This can be done with a daily aspirin for those people with low risks factors for developing a stroke, or treatment with a blood thinner called Coumadin (Warfarin) if the risk of stroke is relatively high. Coumadin is taken daily and unfortunately must be closely monitored by your physician with weekly to monthly blood samples. However cumbersome and inconvenient this may be, it is currently the best way to reduce the risk of developing a stroke.
Treatment is also focused on controlling the heart rate or restoring the heart to a normal heart rhythm. The best way to control the heart rate is with oral medications. This includes many commonly used medications, all of which control the heart rate, yet accept that the heart is still in this erratic mode of contracting. In contrast, rhythm management has the sole purpose of trying to get the heart back into regular rhythm. This too can be done with medications, yet these medications must be given by a heart doctor during very close hospital supervision. Another technique used by heart doctors to restore normal rhythm is to apply a short burst of electrical energy across the chest. This safe procedure, called cardioversion, is only performed in hospital.
Most recently a procedure has been developing in which doctors use small catheters inside the heart to burn abnormal heart tissue that triggers atrial fibrillation. This technique, called ablation, is only performed at specialized heart centers. Once successful, the heart is unable to go back into atrial fibrillation because of the absence of triggers.
In the end, atrial fibrillation is a very common and possibly debilitating heart condition. Appropriate management includes identification of the arrhythmia, immediately control the heart rate and rhythm, and ultimately how best to reduce the risk of stroke. Although not truly life threatening, close management by a heart specialist can greatly improve the overall qualitative life of patients with atrial fibrillation.
David M. Donaldson, MD, is an Auburn native and currently a cardiologist at Massachusetts General Hospital in Boston.
The Citizens' Say
There are No comments posted.