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What is atrial fibrillation?
Atrial
fibrillation is a heart rhythm disturbance. It causes a fast and irregular
heartbeat. It occurs when the smaller, upper chambers of the heart contract in a
very rapid, uncoordinated manner. These upper chambers of the heart are called
the right and left atria.
Fibrillation interferes with the heart's usual steady,
efficient pumping. Because the heart cannot pump the blood as well, your blood
pressure may drop. Your blood then may not be able to deliver enough oxygen to
the tissues of your body, including the heart itself.
How
does it occur?
A
natural electrical impulse causes your heart to go through its pumping motion.
Normally this impulse for each heartbeat begins in the atria of the heart. It
then moves along a specific pathway to the lower chambers of the heart (the
ventricles).
In
atrial fibrillation the usual sequence of events is interrupted. The normal
coordinated contraction (squeezing) of atria and ventricles does not occur. The
atrial muscles quiver and do not coordinate with the ventricular contractions.
This loss of coordination causes each contraction of the heart to lose power. It
also causes loss of the normal control of your heart rate.
Two
common causes of atrial fibrillation are:
- Heart disease, such
as coronary heart disease or heart failure due to many years of high blood
pressure.
- Mitral valve
prolapse, a malfunction of the valve between the left atrium and left
ventricle.
Other causes of atrial fibrillation include:
- Hyperthyroidism
- Pneumonia
- Chronic lung
disease
- Heavy drinking of
alcohol
- Electrolyte
(mineral) imbalances
- Medications, such
as theophylline
Sometimes no cause for the fibrillation can be found.
What are the symptoms?
The
most common symptoms are:
Some
people have chest pain. If your heart is pumping very poorly, your blood
pressure may drop severely and you may faint.
Occasionally, the first symptom is a stroke, caused by a
blood clot that formed in the fibrillating atrium and traveled to the brain.
Some
people have no symptoms.
How
is it diagnosed?
Your
health care provider will ask about your symptoms and examine you. The
diagnosis can be confirmed with an electrocardiogram (ECG). An ECG measures the
electrical activity of your heart. It will show a special pattern for atrial
fibrillation. Your provider will use your medical history, physical exam, and
blood tests to look for a treatable cause of the abnormal heartbeat.
A
helpful additional test is an echocardiogram. This test uses sound waves to
show images of your heart on a computer. It is a way to check for structural
problems, such as an abnormal mitral valve, which might be causing
fibrillations.
How
is it treated?
Initial treatment depends on:
- the severity of
your symptoms
- the apparent cause
of the fibrillation
- your history of
heart problems or stroke
If the
fibrillation is new and is causing severe symptoms, you may be treated with
cardioversion (electrical shock). The electrical shock causes your heart to
begin beating normally again.
If
your symptoms are mild, at first you may be given intravenous medication
(through a vein). Then you may take oral medication over the course of hours to
days. If the medication does not convert the heart to normal rhythm, your health
care provider may try electrical cardioversion (while you are sedated). Often
this is successful.
If a
treatable underlying cause for your fibrillation is found, usually treatment of
the problem will make the fibrillation stop. Otherwise, long-term use of
medication prescribed by your health care provider may be necessary to control
your heart rate. You should avoid stimulants such as caffeine and alcohol.
What are the complications?
The
most serious complication of atrial fibrillation is a stroke caused by a blood
clot in the brain. When the flow of blood slows down in the fibrillating atrium,
the blood may begin to clot. Clots may then travel in the bloodstream to the
brain, where they can block blood flow to a part of the brain and cause a
stroke.
If you
continue to have atrial fibrillation despite treatment, you have a greater risk
of stroke. This is especially true if you have other heart disease or an
artificial heart valve. In this case you may need to take an anticoagulant
(blood thinner) to reduce the risk of clot formation and stroke. If you are less
than 60 years old and do not have other heart disease or an artificial valve,
your risk for stroke is lower and you may not need to take a blood thinner.
If
your atrial fibrillation continues, you are also at risk for fainting or falling
and breaking a bone. This is especially true for elderly women.
How do
I care for someone with atrial fibrillation?
Two
important aspects of caring for someone with atrial fibrillation are:
Make
sure he or she takes the prescribed medications properly.
See
that he or she gets follow-up blood tests to check on the level of anticoagulant
in the blood.
Report
promptly to the health care provider any recurring or new symptoms, such as
episodes of falling or fainting. In certain situations a pacemaker may be
recommended to try to control these symptoms.
How
do I prevent atrial fibrillation?
Having
a lifestyle and diet that is healthy for your heart may help stop atrial
fibrillationfromdeveloping.
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