Heart Health: Atrial Fibrillation

4. Why does atrial fibrillation occur?

Age is the most common risk factor for developing atrial fibrillation and the risk increases with every decade. Atrial fibrillation mainly occurs when there are abnormalities or damage to the heart’s structure. Hypertension, underlying coronary artery disease and abnormalities of the cardiac valves are common causes. Often atrial fibrillation is linked to exposure to alcohol, caffeine and tobacco. Metabolic imbalance, like thyroid disease, is a common and a very treatable etiology. Also, it is extremely common to develop atrial fibrillation after open heart surgery or lung surgery. In many of these post-operative patients, the atrial fibrillation will resolve as they recover from their surgery.  Some medications are also common triggers. For example, steroids that are commonly used to treat asthma or other inflammatory conditions have recently been shown to correlate with the development of atrial fibrillation. There is also a clear correlation to stress and the development of atrial fibrillation. Stress can also make the symptoms of atrial fibrillation worsen and more difficult to treat.

There are some people who develop atrial fibrillation without any obvious cause and they have a structurally normal heart, a condition called lone atrial fibrillation. Typically, these people with lone atrial fibrillation are younger people and the complications are rare.

5. What tests should be ordered a diagnosis of atrial fibrillation is made?

The diagnosis of atrial fibrillation is typically made on physical examination and confirmed with an electrocardiogram, or ECG. Since an ECG is simply a “snap shot” of the heart, often this won’t capture the atrial fibrillation. A holter monitor is a 24-hour monitor that may also be prescribed to evaluate if the atrial fibrillation is intermittent or continuous. There are also monitors that can be placed for a week and even longer if needed to fully evaluate the duration of atrial fibrillation and the control of the rate. These monitors continuously record the heart’s electrical activity.  Once the diagnosis is made, other tests need to be performed to evaluate for the etiology of the atrial fibrillation. An echocardiogram is an ultrasound of the heart muscle and the cardiac valves and can rule out a structural etiology or a valve abnormality as the underlying cause. Routine blood tests to evaluate the thyroid, rule out anemia and check the liver and kidneys are important. An evaluation for underlying coronary artery disease must also be pursued if there is no obvious cause.  A chest X-ray can also be important in the workup of atrial fibrillation as it can evaluate for chronic lung disease or an underlying infection.

6. What are the complications if the atrial fibrillation is not diagnosed and treated correctly?

By itself, atrial fibrillation is usually not life threatening. However, if left untreated the side effects of atrial fibrillation can be life threatening. The two main complications of atrial fibrillation are stroke and the development of a cardiomyopathy or weakened heart.

The stroke risk is great because atrial fibrillation pumps blood less efficiently and as the blood moves slower, it is more likely to form clots. If the clot is pumped out of the heart, it can travel to the brain and lead to a stroke.

The other complication of atrial fibrillation is the development of a cardiomyopathy or a weakened heart. Without appropriate treatment, atrial fibrillation can cause a fast heart rate for a long period. This continuous fast heart rate can cause the heart muscle to weaken. To prevent one of these complications, treatment for atrial fibrillation includes one medication to either control the rate or rhythm and the other to prevent stroke.

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  • M. M. Greenebaum February 27, 2017 at 12:28 pm

    Greetings. I read this with interest, thank you. Having had atrial fib from the time I was a young child, I was able to control it by squatting down, holding my breath, and applying pressure on my solar plexis. Eventually, as an adult, this solution worked less and less reliably! and I finally had an ablation which solved the problem. During the years before the ablation, however, I often was sent to the emergency room, by my cardiologist, where I was given an injection (sorry not to remember what) which immediately corrected it.