Dr. M.J. Bazos, MD
Patient Handout
ATRIAL
FIBRILLATION
About Your
Diagnosis
Fibrillation is a type of abnormal contraction
in a muscle. In the heart the atria and ventricles must squeeze in a coordinated
way to move the blood effectively. A fibrillating muscle looks as if it is
wiggling rather than squeezing and does not move blood the way a normal
contraction does. If this occurs in the atrium, the blood inside is not pumped
into the ventricle normally and tends to pool. The ventricles can pull most of
the blood in and contract to push it out, which allows the heart to perform most
of its function. Pooling of blood and inefficient movement of blood through the
atrium may cause other problems. If the pooled blood clots, the clots can be
sent into the bloodstream and can cause heart attacks or strokes. When the
atrium is fibrillating, it is attempting to contract (but the contractions are
small) and may signal the ventricle to contract. Because the fibrillation is
irregular and fast (wiggling), the contractions are irregular and fast. The
ventricles contract when signaled and beat fast. This abnormal rhythm of the
heartbeat is arrhythmia. Because the ventricles are not filling with
blood normally, they must work harder to supply blood to the body and may
eventually go into heart failure.
Living
With Your Diagnosis
Many things can
cause atrial fibrillation. Many persons have atrial fibrillation and never feel
it. The most common cause is aging, because the heart becomes more susceptible
to changes. Heart and lung disease, other illnesses, and stress also can cause
atrial fibrillation. Caffeine, nicotine (cigarettes), and excess alcohol can
cause it or make it worse. Symptoms of atrial fibrillation are commonly the
feeling that the heart is beating irregularly or too fast (palpitations).
Symptoms of heart failure such as difficulty breathing, chest pain, or fainting
may occur. Some persons feel fatigued or have difficulty with exercise. If there
has been fibrillation for some time and clots have formed, chest pain or signs
of stroke are dangerous and must be evaluated immediately. Atrial fibrillation
is diagnosed on the basis of a particular pattern of pulses and tracings on an
electrocardiogram (ECG). The physician may check the motion of the atrium with
an echocardiogram (ultrasound examination of the heart). This examination can
show whether there are clots in the
atrium.
Treatment
Management
of atrial fibrillation focuses on the underlying cause. For example, if there is
thyroid disease, the patient is treated for this condition. If the fibrillation
is caused by too much caffeine, reduction of caffeine intake is recommended.
While the cause is being sought or being treated, relief of symptoms depends on
what the patient experiences or feels. Heart disease, for example, can be
managed, but the fibrillation may not revert to normal. Fibrillation can be
managed with digitalis (digoxin) to help control the rate at which the
ventricles contract. It also makes ventricular contractions more efficient.
Digoxin therapy often is started in the hospital so that the level of drug in
the body and changes in heart rhythm can be monitored. If digoxin therapy
continues outside the hospital, the level of the drug in the blood has to be
measured periodically. If clots have formed in the atrium, anticoagulants such
as warfarin (eg, Coumadin) may be prescribed. This drug can cause easy bruising
or bleeding, and
levels are checked
periodically. Arrhythmia may be managed with an antiarrhythmic drug such as
verapamil or propranolol. This drug also may lower the blood pressure and cause
headaches, dizziness, or nausea. The abnormal rhythm of the heart from atrial
fibrillation sometimes has to be electrically shocked back to normal. This
procedure is called cardioversion. If you are taking medicine to manage
thyroid, heart, or lung disease, for example, the drugs should be taken as
directed to avoid more fibrillation.
The
DOs
•Stop
smoking.
•Reduce your intake of
alcohol or caffeine.
•Eat a diet that
is healthful for your heart. Decrease fat and cholesterol.
•Lose
weight.
•Minimize your stress as much
as possible, because stress can worsen
you.
•Exercise to your level of
tolerance if you are taking the proper medications and have no
symptoms.
•Take your medicines as
prescribed, and have drug blood levels
monitored.
The
DON’Ts
•Avoid activities
that cause bruising if you are taking
anticoagulants.
When to Call Your
Doctor
•If you have side effects
from your medications or if you have new or worsening symptoms. This includes
chest pain, shortness of breath or difficulty breathing, fainting, palpitations,
or sudden changes in the ability to speak, eat, walk, or use your
limbs.
•If you are taking
anticoagulants and sustain a serious cut or head injury.