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Understanding Atrial Fibrillation: Causes, Symptoms, and Management

Ryan Davies

Atrial Fibrillation (AF) is the term used when your heart beats in an irregular pattern and is often beating too fast. This may first be noticed as palpitations and can be diagnosed on an ECG. Some blood pressure meters can also help detect irregular heartbeats.

Some people have AF that comes and goes – this is known as paroxysmal atrial fibrillation and can be harder to diagnose as it may have resolved before you get the chance to be assessed.

The cause of AF is unknown, but it is associated with conditions such as high blood pressure, heart disease, and older age.

The heart consists of four chambers, with the upper two chambers known as the atria and the bottom two the ventricles. Your heart has natural pacemaker cells that control electrical signals and in a healthy heart, they conduct the signals so that your heart beats in a regular pattern.

When the heart is beating irregularly, blood can remain left over in the top chambers and is at a higher risk of clotting, this clot may then end up being pumped directly from the heart to the brain – resulting in a stroke.

Atrial fibrillation also means that your heart doesn’t get as much opportunity to relax in comparison to a healthy heart and this can sometimes lead to heart failure.

Common symptoms

Symptoms of AF include:

-          Rapid heartbeat

-          Reduced exercise tolerance and/or tiredness

-          Chest pain

-          Feeling lightheaded

-          A heart rate that is not between 60 to 100 beats per minute

Often people with AF do not experience symptoms and it is identified on a routine ECG.

Managing AF

Medication can be used to both reduce risk of stroke and control the heart’s rate and rhythm. Taking your medicine as prescribed is important to reduce strain on your heart and reduce your risk of complications.

You may be offered anticoagulant treatment with a direct oral anticoagulation (DOAC - Apixaban, Edoxaban, Rivaroxaban) which have largely replaced the older medication Warfarin. Warfarin is still offered to some patients, such as those with metallic heart valves, but requires frequent blood monitoring so is no longer the preferred choice. These medicines will reduce your chances of a clot forming and prevent the risk of stroke.

You may be offered medicines to slow your heart rate and bring it down to a safer level. This can increase the chances of the heart returning to normal rhythm.

Depending on the type of AF you have, you may be offered medicines to revert your heart back into normal rhythm. You may also be offered procedures such as ablation to correct the electrical signals in your heart.

If you have paroxysmal AF that comes and goes – you may be offered a ‘pill in the pocket strategy’ which means you only take medication when you experience symptoms.

Healthy Living Advice

Maintaining a healthy weight and taking regular physical exercise can help to reduce the amount of strain on your heart. The NHS recommends that adults do at least 150 minutes of moderate activity per week (or 75 minutes of intense activity per week) spread evenly throughout the week.

Lower your blood pressure by improving your diet. The NHS advises limiting salt to no more than 6g a day and limiting the consumption of foods high in saturated fats such as fatty cuts of meat, butter, and cakes as this can increase the level of bad cholesterol in your blood.

Eating foods high in unsaturated fats can increase your levels of good cholesterol, including oily fish, nuts, seeds, and olive oil.

Smoking can increase the likelihood of developing atrial fibrillation. Stopping smoking is a great decision to reduce your chances of being diagnosed with almost all disease relating to the heart and lungs. Find your local stop-smoking service here.

Resources

The Stroke Association has a wealth of great information helping you to understand your stroke risk with atrial fibrillation.

Cardiomyopathy – the heart muscle charity run regular online support groups for those with atrial fibrillation – consider signing up for a free session here.

The AF Association has an abundance of resources including posters, fact sheets and videos about all things atrial fibrillation.

Sources