Atrial fibrillation, also known as AF is a rhythm disturbance of heart where it beats irregularly.
The main risk for this condition is that it can cause blood to clot and cause Stroke.
Let us try to understand, what happens during Atrial Fibrillation.
The heart will usually beat following a regular rhythm.
This sinus node which is the pacemaker of the heart discharges electricity at a regular interval which leads the heart to beat in regular rhythm.
In Atrial Fibrillation the natural pacemaker of the heart does not work efficiently anymore.
Therefore instead of regular electrical discharges from the sinus node, there happens to be electrical impulses originating from all over the atrium (upper chambers of heart) in an irregular fashion; thus resulting in the heart to beat irregularly.
The main risk of this condition is that it causes blood to clot within the heart.
This clot can then break away when the heart pumps to various parts of the body and cause occlusion of blood vessels in major organs thus causing irreversible structural and functional damage.
The main risk is for the clot to go the brain and cause strokes. The risk of Stroke from Atrial fibrillation can vary from person to person and increases with age.
Other medical co morbidities like Hypertension (Blood Pressure), heart failure, Diabetes also increases this risk.
Atrial Fibrillation can be classified or described in two ways.
Abnormalities or any kind of damage to the structure of the heart is one of the most common causes of atrial fibrillation.
Some of the possible causes of atrial fibrillation are:
There are people, who suffer from atrial fibrillation but they do not have any defects in THE heart or any kind of damage. This is called Idiopathic Atrial Fibrillation.
Some of the risk factors of atrial fibrillation are:
Diagnosis of Atrial Fibrillation depends on examination of the pulse and cardiovascular system. An ECG is confirmatory of Atrial Fibrillation.
In paroxysmal Atrial Fibrillation a single ECG may not capture the abnormal rhythm and a more prolonged cardiac monitor (Holter) may be needed to capture the heart rhythm at the point where it became irregular.
The doctor will recommend several tests to diagnose AF and also to look for causes.
The treatment of AF has three major aims:
Ans: Absolutely not. Atrial Fibrillation is a disorder of the electrical system of the heart resulting in an abnormal and irregular rhythm of the heart.
Heart attack is caused by a clot blocking of a blood vessel and circulation in the heart. They are essentially disorders of two different systems of the heart.
Ans: In some cases it is possible to reverse the irregular rhythm of the heart in AF to a normal rhythm called sinus rhythm.
This can be done either by delivering a controlled electric shock to the heart or by certain medicines of the antiarrhythmic class.
However it is much more difficult to keep the heart in the normal rhythm in these cases.
A vast majority will just revert back to AF after some time.
Several factors determine whether the AF rhythm can be reversed and kept in normal sinus rhythm.
Age, absence of ischaemic heart disease and a structurally normal heart (as confirmed by echocardiogram) are some of the key factors.
Another interesting option could be doing electrophysiological (EP) studies on the heart’s intrinsic electrical circuit.
In certain cases there are abnormal pathways or tracts carrying the abnormal electric circuit leading to AF.
The EP studies can identify those tracts if present. One potential treatment option will be to ablate that pathway via laser ablation and other methods.
However this may lead to a need for permanent pacemaker implantation in the aftermath.
Ans:Usually AF itself is not life threatening.
On certain occasions AF can make the heart go very fast leading to concerning symptoms.
However this can be relatively comfortably controlled by medication or delivering a controlled electrical shock to the heart.
The most concerning feature of AF is however the risk of brain stroke that it confers.
In AF blood does not circulate well inside the heart leading to formation of clot inside the heart.
Eventually when the heart contracts these clots are showered out of the heart thereby blocking any blood vessel that they go in.
Most commonly they travel up the neck blood vessels into the brain and blocks of one of the major brain blood vessels causing large strokes.
This is the most life threatening complication of AF.
Ans: Most commonly AF is actually asymptomatic i.e. it gives no symptoms.
Hence it remains impossible for the patient to know that the heart is going irregular and take adequate precautions.
Quite often AF is discovered once it has striked the fatal blow in the form of a major brain stroke.
In a small proportion of cases, mainly younger ones, AF may present with some symptoms which include shortness of breath, chest pain and palpitations.
Ans: There are two strategies to manage AF.
There are 5 major medical trials which showed that rate control and rhythm control strategies are both equally effective in managing AF; however anticoagulation is of paramount importance whatever strategy you choose.
Ans:Patients with AF if managed appropriately with rate or rhythm control strategies and adequately anticoagulated should have a normal life expectancy.
Ans:In certain cases where the heart tends to race or beat very fast in AF it can cause some symptoms like shortness of breath, chest pain and palpitations.
Ans:There is no relation between high blood pressure and AF.
Dr. Dwaipayan Sen is a Consultant Stroke Physician and Clinical Lead for Comprehensive Stroke Services (Salford Hope Hospital, UK)
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