• Lori Boyajian-O'Neill: How much do you know about atrial fibrillation?

  • September is Atrial Fibrillation Awareness Month – who knew? Well, about 2.2 million Americans know firsthand about AF, the familiar fluttering in the chest, chest pain and shortness of breath

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  • September is Atrial Fibrillation Awareness Month – who knew? Well, about 2.2 million Americans know firsthand about AF, the familiar fluttering in the chest, chest pain and shortness of breath. Sometimes AF is silent and stealth, without symptoms. Many advances in recent years have made living with AF much easier. AF, what do you know, T or F?
    1. AF is the most common abnormal heart rhythm seen by physicians.
    2. AF causes about 20,000 strokes annually.
    3. AF costs over $6.6 billion annually.
    The heart, a muscle with chambers and valves, is operated by an electrical system. When the electrical impulses are abnormal, an irregular rhythm and heart rate can result. Most often, this rhythm is atrial fibrillation. The atria are the top two chambers of the four-chamber human heart. Overactive electrical signals cause the atria to contract in a haphazard, non-rhythmic manner. It would be like the Kansas City Symphony string section playing out of sync with the brass section. Chaos.
    Instead of rhythmic atrial contraction driving blood into the ventricles, the atria beat quickly or fibrillate and less blood is delivered to the ventricles, resulting in heart failure. Normal heart rate is generally considered between 60-100 beats per minute. AF can cause heart rates between 100-175 beats per minute leaving the patient feeling as if he might pass out. These symptoms are present because the heart is not pumping an adequate volume of blood to the brain.
    Risk factors for AF include older age (over 65 years), high blood pressure, prior heart or lung disease, stimulants such as caffeine, alcohol, obesity, sleep apnea and others. Some have no risk factors whatsoever. AF can be present on occasion or daily. Stroke and heart failure are the major complications associated with AF. As the blood cells cascade through the irregularly beating heart, they may clump and form clots. If these clots exit the heart and travel to the brain, a stroke occurs. About 15-20 percent of all strokes are caused by AF, about 70,000 annually. Blood thinners may be prescribed to decrease this risk.
    AF is usually diagnosed by detecting rhythm abnormalities on electrocardiogram, Holter and event monitors. Echocardiograms, chest x-rays and lab work may help identify underlying causes of AF. For example, blood tests may implicate thyroid disease or echocardiogram or chest x-rays may reveal underlying heart or lung disease.
    There are 2 main goals of treatment. First to restore normal rhythm and heart rate and second to prevent stroke. Treatment is based on severity of arrhythmia and symptoms. Cardioversion is the term for converting abnormal heart rhythm to normal rhythm. Medications and electrical stimulation are used for cardioversion. Usually, medication is tried first. If this fails, electric cardioversion, where a cardiologist zaps or (more delicately stated) delivers an electrical impulse to the heart in an effort to restore normal rhythm, is performed. If these approaches fail, more invasive procedures called ablation or surgery may be needed.
    Page 2 of 2 - Once the normal rhythm is restored, the patient is usually placed on medications to control heart rate and rhythm and prevent stroke. Aspirin, warfarin (Coumadin), dabigatran (Pradaxa) and rivaroxaban (Xarelto) are commonly prescribed. Lifestyle modifications including healthy diet and exercise and treatment of underlying diseases may prevent recurrence.
    For more information about AF contact the National Heart Lung and Blood Institute at http://www.nhlbi.nih.gov/health/health-topics/topics/af
    Answers: 1. T; 2. F; 70,000 3. T.

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