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Atrial fibrillation

Overview

Atrial fibrillation is an irregular and often fast heartbeat. Treating this condition is important for several reasons. It can cause blood clots, which can travel from your heart to your brain and cause a stroke. If you have a fast heartbeat, you may feel lightheaded, dizzy, and weak. An irregular heartbeat can also increase your risk for heart failure.

Atrial fibrillation is often the result of another heart condition, such as high blood pressure or coronary artery disease. Making changes to improve your heart condition will help you stay healthy and active.

  • Symptoms

    What are the symptoms of atrial fibrillation?

    Some people feel symptoms when they have episodes of atrial fibrillation. But other people don’t notice any symptoms.

    If you have symptoms, you may feel:

    • A fluttering, racing, or pounding feeling in your chest called palpitations.
    • Weak or tired.
    • Dizzy or lightheaded.
    • Short of breath.
    • Chest pain.
    • Confused.

    You may notice signs of atrial fibrillation when you check your pulse. Your pulse may seem uneven or fast.

  • Causes

    Atrial fibrillation

    Right and left atria of heart with details showing fibrillation in an atrium, and EKG patterns of fibrillation and normal rhythm.

    In atrial fibrillation, erratic electrical impulses in the upper chambers of the heart (atria) cause those chambers to fibrillate, or quiver. This results in an irregular and frequently rapid heart rate. The irregular pattern in the electrocardiogram (EKG, ECG) tracing shows these erratic impulses.

    What causes atrial fibrillation?

    Atrial fibrillation is caused by a problem with the heart's electrical system. When something goes wrong with this system, it's usually because of other health problems that are causing wear and tear on the heart or making it hard for the heart to do its job.

    Conditions that damage or strain the heart are the most common causes of atrial fibrillation. These include:

    • High blood pressure.
    • Coronary artery disease.
    • Heart attack.
    • Heart failure.
    • Heart valve disease.

    Other possible causes include:

    • Having heart surgery or other open-chest surgery.
    • Hyperthyroidism.
    • Lung disease, such as COPD or pneumonia.
    • Drinking a large amount of alcohol at one time (binge drinking).

    In some cases, doctors can't find the cause of atrial fibrillation.

  • Diagnosis

    How is atrial fibrillation diagnosed?

    To see if you have atrial fibrillation, you will have an electrocardiogram (EKG or ECG). An EKG is a test that checks for problems with the heart's electrical activity.

    Your doctor will probably ask questions about your past health and do a physical exam.

    Other tests your doctor may recommend include:

    Ambulatory electrocardiogram.
    For this test, you wear a device that records the electrical activity of your heart while you do your usual activities. You may have this test if your doctor suspects that you have atrial fibrillation that comes and goes.
    Electrophysiology (EP) study.
    This test can help your doctor see if there is a problem with your heartbeat (heart rhythm) and find out how to fix it.
    Echocardiogram.
    This test can show if your heart valves are damaged, how well your heart is pumping, and if you have heart failure or have had a heart attack.
    A blood test.
    You may have a blood test to check for hyperthyroidism.
  • Treatment

    How is atrial fibrillation treated?

    Treatments can help you feel better and prevent future problems, especially stroke and heart failure.

    Your treatment will depend on the cause of your atrial fibrillation, your symptoms, and your risk for stroke. Types of treatment include:

    • Heart rate treatment. Medicine may be used to slow your heart rate. Your heartbeat may still be irregular. But these medicines keep your heart from beating too fast. They may also help relieve symptoms.
    • Heart rhythm treatment. Different treatments may be used to try to stop atrial fibrillation and keep it from returning. They can also relieve symptoms. These treatments include medicine, electrical cardioversion to shock the heart back to a normal rhythm, a procedure called catheter ablation, and heart surgery.
    • Stroke prevention. You and your doctor can decide how to lower your risk. You may decide to take a blood-thinning medicine called an anticoagulant.
  • Decision

    How can you decide between electrical cardioversion and rate control medicines for atrial fibrillation?

    What is atrial fibrillation?

    Atrial fibrillation (say “AY-tree-uhl fih-bruh-LAY-shun”) is a kind of uneven heartbeat. It can make you feel lightheaded and dizzy. You may feel weak. It also can make you more likely to have a stroke.

    Electrical cardioversion can return your heart to a normal rhythm. First you’ll get medicines to make you sleepy and control pain. Then your doctor will use patches to send an electric current to your heart. This resets the rhythm of your heart.

    Not everyone with atrial fibrillation needs this treatment. For some people, taking medicines may be better. Most people can live with an uneven heartbeat. It just has to be kept under control so the heart does not beat too fast.

    Use this information to help you and your doctor decide which treatment to choose for atrial fibrillation.

    What are key points about this decision?

    • Electrical cardioversion can return your heart to a normal rhythm. But the problem can come back. The longer you have had atrial fibrillation, the more likely it is to come back after this treatment.
    • Cardioversion may not work as well when an uneven heartbeat is caused by another heart disease, such as heart failure.
    • If your symptoms bother you a lot, you may want to try cardioversion. But even if it works, you may still need to take blood thinners to prevent a stroke.
    • If you don’t have symptoms, or if they don’t bother you much, you can try medicines to slow your heart rate. And you can take blood thinners to prevent a stroke.
    • Cardioversion does have risks, such as stroke. Discuss the risks with your doctor. Make sure you understand them.
    • You may have more than one heart problem. Cardioversion doesn’t work as well if you have more than one heart problem.

    Why might you choose electrical cardioversion?

    • It restores the normal heart rhythm for most people.
    • The idea of having an electric shock does not bother you.
    • Your symptoms bother you a lot.
    • You have had atrial fibrillation just one time.
    • You do not have other heart problems.
    • You may not have to take as many medicines. Or you may not need to take them as long.

    Why might you choose rate-control medicines?

    • These medicines keep many people from having symptoms.
    • You prefer to take medicines rather than have an electric shock.
    • Your symptoms don’t bother you much.
    • If these medicines don’t work, you can still try electrical cardioversion.

    Your decision

    Thinking about the facts and your feelings can help you make a decision that is right for you. Be sure you understand the benefits and risks of your options. And think about what else you need to do before you make the decision.

  • When to Call

    Atrial fibrillation: When to call

    Call 911 anytime you think you may need emergency care. For example, call if:

    • You have symptoms of a heart attack. These may include:
      • Chest pain or pressure, or a strange feeling in the chest.
      • Sweating.
      • Shortness of breath.
      • Nausea or vomiting.
      • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
      • Lightheadedness or sudden weakness.
      • A fast or irregular heartbeat.
      After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
    • You have symptoms of a stroke. These may include:
      • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
      • Sudden vision changes.
      • Sudden trouble speaking.
      • Sudden confusion or trouble understanding simple statements.
      • Sudden problems with walking or balance.
      • A sudden, severe headache that is different from past headaches.
    • You passed out (lost consciousness).

    Call your doctor now or seek immediate medical care if:

    • You have new or increased shortness of breath.
    • You feel dizzy or lightheaded, or you feel like you may faint.
    • Your heart rate becomes irregular.
    • You can feel your heart flutter in your chest or skip heartbeats. Tell your doctor if these symptoms are new or worse.

    Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

  • Self-Care

    How can you care for yourself when you have atrial fibrillation?

    Many people are able to live full and active lives with atrial fibrillation.

    Because atrial fibrillation is often the result of a heart condition, making changes to improve your heart condition will usually improve your overall health.

    Have a heart-healthy lifestyle.
    Eat heart-healthy foods, be active, stay at a healthy weight, and don't smoke. A heart-healthy lifestyle may help reduce how often you have episodes of atrial fibrillation. If you are overweight, losing weight can help relieve symptoms.
    Take medicine properly and safely.
    Take your medicine exactly as prescribed. If you take a blood thinner, be sure you get instructions about how to take your medicine safely.
    Manage other health problems.
    Manage diabetes, high blood pressure, and high cholesterol. Tell your doctor if you have symptoms of sleep apnea.
    Manage symptoms.
    Work with your doctor to treat your symptoms and make an action plan for episodes.

    Living well with atrial fibrillation

    Most people with atrial fibrillation don't have to change their daily activities. You can live well and safely with atrial fibrillation. Here are some tips on preventing problems with arrhythmia.

    • Try to lower the amount of stress at work or with family.

      You can try meditation and other relaxation techniques when stress is unavoidable. Stressful situations can trigger an episode of atrial fibrillation or make your atrial fibrillation worse.

    • Avoid strenuous activity and extremely stressful situations at work.

      Most people with atrial fibrillation can continue working.

    • Let your doctor know if you experience symptoms of atrial fibrillation during sex.

      Most people with atrial fibrillation can lead normal sex lives as long as they can exercise and be active without having symptoms.

    • Call your doctor to report any symptoms you have while exercising.

      Avoid strenuous exercise if it causes symptoms. Intense exercise may trigger your arrhythmia or make your symptoms worse. Talk to your doctor before you start a new exercise program or change your workouts.

    • Pull over and call your doctor if you start to feel symptoms or become lightheaded while driving or using heavy machinery.

      You can drive unless your doctor advises against it.

    • Prepare before you travel.

      Bring the name and phone number of your doctor when you go on trips. Before each trip, talk with your doctor about your travel plans. He or she may be able to refer you to a doctor in the area that you will be visiting in case your arrhythmia comes back and you need medical attention. Also, make sure to bring extra medicine.


    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.